Kapitanov D N, Shelesko E V, Potapov A A, Kravchuk A D, Zinkevich D N, Nersesyan M V, Satanin L A, Sakharov A V, Danilov G V
Burdenko Neurosurgical Institute, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2017;81(2):38-47. doi: 10.17116/neiro201781238-47.
The study purpose was to determine the successful outcome rate of endoscopic endonasal reconstruction of skull base CSF fistulas with removal of meningocele as well as analyze disease relapses. The second purpose of the study was to describe the treatment outcomes, depending on the type, location, and size of meningocele as well as on a technique used to reconstruct the skull base defect.
Three hundred and eleven patients diagnosed with cerebrospinal fluid (CSF) rhinorrhea who underwent surgery at the Burdenko Neurosurgical Institute in the period between 2007 and 2014 were retrospectively analyzed. Meningocele was detected in 141 (45.3%) of all patients with CSF rhinorrhea. The diagnosis was made before surgery and verified during endoscopic endonasal reconstructive closure of skull base defects. Therefore, the analysis group included all cases of meningocele and meningoencephalocele verified during surgery. The study analyzed the gender, age of surgery, follow-up period, comorbidities, use of lumbar drainage, etiology of the defect, localization, type of reconstructive material, complications, and disease relapses. We defined the efficacy of endoscopic endonasal meningocele resection with fistula reconstruction as the absence of signs of CSF rhinorrhea and a hernia sac based on the data of control CT and endoscopy performed in the late postoperative period. The follow-up period ranged from 1 month to 5 years.
All patients underwent endoscopic endonasal reconstruction of the skull base defect. The treatment efficacy was 110 (78%) patients for primary surgery and 26 (84%) patients for repeated surgery.
Endoscopic endonasal surgery is a safe, effective, and minimally invasive technique for treatment of meningocele and meningoencephalocele, which enables resection of a hernia sac and reconstruction of dura mater and skull base defects.
本研究旨在确定在内镜下经鼻重建颅底脑脊液瘘并切除脊膜膨出的成功治愈率，同时分析疾病复发情况。本研究的第二个目的是根据脊膜膨出的类型、位置、大小以及用于重建颅底缺损的技术来描述治疗效果。
回顾性分析了2007年至2014年间在布尔坚科神经外科研究所接受手术的311例诊断为脑脊液鼻漏的患者。在所有脑脊液鼻漏患者中，141例（45.3%）检测到脊膜膨出。术前做出诊断，并在内镜下经鼻重建颅底缺损时得到证实。因此，分析组包括手术中证实的所有脊膜膨出和脑膜脑膨出病例。本研究分析了性别、手术年龄、随访期、合并症、腰大池引流的使用、缺损的病因、定位、重建材料类型、并发症和疾病复发情况。根据术后晚期进行的对照CT和内镜检查数据，我们将内镜下经鼻切除脊膜膨出并重建瘘管的疗效定义为无脑脊液鼻漏和疝囊迹象。随访期为1个月至5年。
所有患者均接受了内镜下经鼻重建颅底缺损手术。初次手术的治疗有效率为110例（78%），再次手术的治疗有效率为26例（84%）。
内镜下经鼻手术是治疗脊膜膨出和脑膜脑膨出的一种安全、有效且微创的技术，能够切除疝囊并重建硬脑膜和颅底缺损。
