Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
College of Medicine, Korea University, Seoul, Republic of Korea.
J Clin Neurosci. 2017 Nov;45:227-231. doi: 10.1016/j.jocn.2017.07.012. Epub 2017 Jul 29.
Endoscopic transnasal surgery for tumors located at the base of the skull has a high incidence of postoperative cerebrospinal fluid (CSF) leaks. Here, we assessed the repair outcomes for high-flow CSF leaks based upon the tumor location, and analyzed the reasons for repair failure after transnasal endoscopic surgery solely for tumors involving the base of the skull. From Feb. 2009 to Dec. 2014 we performed endoscopic endonasal surgery for a variety of skull base lesions in 788 patients at our institution. Among them, 95 patients with intradural skull base tumors underwent endoscopic transnasal surgery. We performed surgical repairs with a multilayered nonvascularized construct (38 patients) and a vascularized pedicled nasoseptal flap construct combined with a fascia graft (57 patients). Overall, 14 of 95 patients (14.7%) who underwent endoscopic transnasal surgery for skull base tumors developed postoperative CSF leaks. The major causes of repair failure included graft disruption by a lack of counter-pressure in the multilayered non-vascularized technique, and inadequate drilling of the sphenoid bone, displacement of the flap due to pressure from CSF or gravity, or disruption of flap integrity in the vascularized pedicled flap technique. Logistic regression analysis revealed that there was no significant association between repair failure and age, sex, type of reconstructive method used, and primary tumor type (p>0.05). Reconstruction after endoscopic endonasal surgery remained challenging, especially for non-pituitary skull base tumors requiring intra-arachnoidal dissection. Recent advances in reconstructive techniques require the accumulation of experiences with sufficient dexterity to achieve an acceptable morbidity rate.
内镜经鼻手术治疗颅底肿瘤术后脑脊液（CSF）漏发生率较高。在此，我们根据肿瘤位置评估了高流量 CSF 漏的修复效果，并分析了单纯内镜经鼻手术治疗颅底肿瘤后修复失败的原因。2009 年 2 月至 2014 年 12 月，我们在我院对 788 例颅底病变患者进行了各种内镜经鼻手术。其中，95 例硬脑膜内颅底肿瘤患者接受了内镜经鼻手术。我们采用多层非血管化结构（38 例）和血管化带蒂鼻中隔瓣结构联合筋膜移植（57 例）进行手术修复。总的来说，95 例行内镜经鼻手术治疗颅底肿瘤的患者中有 14 例（14.7%）发生术后 CSF 漏。修复失败的主要原因包括多层非血管化技术中缺乏对抗压力导致移植物破裂、蝶骨钻孔不足、由于 CSF 或重力的压力导致皮瓣移位、或血管化带蒂皮瓣技术中皮瓣完整性受损。Logistic 回归分析显示，修复失败与年龄、性别、使用的重建方法类型以及原发性肿瘤类型之间无显著相关性（p＞0.05）。内镜经鼻手术后的重建仍然具有挑战性，尤其是对于需要蛛网膜下腔解剖的非垂体颅底肿瘤。最近重建技术的进步需要积累足够的经验和灵巧性，以达到可接受的发病率。
