Pereira Erlick A C, Grandidge Carly A, Nowak Victoria A, Cudlip Simon A
Academic Neurosurgery Unit, St George's, University of London, London, UK.
Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.
J Clin Neurosci. 2017 Oct;44:6-10. doi: 10.1016/j.jocn.2017.06.016. Epub 2017 Jul 1.
To investigate cerebrospinal fluid (CSF) leak rates after mainly endoscopic endonasal transsphenoidal surgery with and without polyethylene glycol hydrogel dural sealant (DuraSeal®), we prospectively collected data from a single-centre consecutive case series over four years from January 2007 to December 2010 inclusive. 250 patients were identified (135 male, 115 female; median age 52years, range 14-83). 180 patients received DuraSeal® (72%). 85 (34%) had intra-operative dural breach and 13 (5.2%) developed post-operative CSF leaks (3 without intra-operative dural breach) requiring lumbar drainage or formal repair. Of this group 5/251 (2.0%) patients required a formal repair. Post-operative CSF leak was seen in 5/189 (2.7%) of patients with pituitary adenoma, of which 2/5 (40%) were in cases undergoing revision surgery. 5/13 (38.4%) patients who developed a CSF leak presented with either Rathke's cleft cyst or craniopharyngioma. 3/71 patients not receiving DuraSeal® leaked (4.2%) and 10/180 patients receiving DuraSeal® leaked (5.6%). 11/234 patients without Tisseel (4.7%) and 2/16 receiving Tisseel (12.5%) leaked. 54 patients (22%) received intra-operative lumbar drains, one of whom developed subsequent CSF leak (1.9%), in contrast to 12/197 (6.1%) of patients without intra-operative lumbar drains who later developed CSF leak. The rate of post-operative CSF leak requiring re-exploration and nasoseptal flap repair was low (2.0%) in this mainly endoscopic case series without statistically significant benefit from either DuraSeal® or Tisseel. Intra-operative and post-operative lumbar drainage appears beneficial in patients at higher risk of post-operative CSF leak.
为了研究在主要采用内镜经鼻蝶窦手术且使用或不使用聚乙二醇水凝胶硬脑膜密封剂（DuraSeal®）的情况下脑脊液（CSF）漏出率，我们前瞻性地收集了2007年1月至2010年12月这四年间来自单中心的连续病例系列数据。共确定了250例患者（男性135例，女性115例；年龄中位数52岁，范围14 - 83岁）。180例患者使用了DuraSeal®（72%）。85例（34%）术中出现硬脑膜破裂，13例（5.2%）出现术后脑脊液漏（其中3例术中无硬脑膜破裂），需要进行腰椎引流或正式修复。该组中5/251（2.0%）的患者需要正式修复。垂体腺瘤患者中5/189（2.7%）出现术后脑脊液漏，其中2/5（40%）发生在接受翻修手术的病例中。发生脑脊液漏的5/13（38.4%）患者患有拉克氏裂囊肿或颅咽管瘤。未使用DuraSeal®的71例患者中有3例漏出（4.2%），使用DuraSeal®的180例患者中有10例漏出（5.6%）。未使用纤维蛋白胶（Tisseel）的234例患者中有11例漏出（4.7%），使用Tisseel的16例患者中有2例漏出（12.5%）。54例患者（22%）术中接受了腰椎引流，其中1例随后出现脑脊液漏（1.9%），相比之下，未术中接受腰椎引流的197例患者中有12例（6.1%）后来出现脑脊液漏。在这个主要为内镜手术的病例系列中，需要再次探查和鼻中隔瓣修复的术后脑脊液漏发生率较低（2.0%），使用DuraSeal®或Tisseel均未显示出统计学上的显著益处。术中及术后腰椎引流似乎对术后脑脊液漏风险较高的患者有益。
