Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Int Forum Allergy Rhinol. 2019 Jul;9(7):795-803. doi: 10.1002/alr.22313. Epub 2019 Feb 12.
Although recent guidelines for obstructive sleep apnea recommend early postoperative use of continuous positive airway pressure (CPAP) after endonasal skull base surgery, the time of initiation of CPAP is unclear. In this study we used a novel, previously validated cadaveric model to analyze the pressures delivered to the cranial base and evaluate the effectiveness of various repair techniques to withstand positive pressure.
Skull base defects were surgically created in 3 fresh human cadaver heads and repaired using 3 commonly used repair techniques: (1) Surgicel™ onlay; (2) dural substitute underlay with dural sealant onlay; and (3) dural substitute underlay with nasoseptal flap onlay with dural sealant. Pressure microsensors were placed in the sphenoid sinus and sella, both proximal and distal to the repair, respectively. The effectiveness of each repair technique against various CPAP pressure settings (5-20 cm H O) was analyzed.
Approximately 79%-95% of positive pressure administered reached the sphenoid sinus. Sellar pressure levels varied significantly across the 3 repair techniques and were lowest after the third technique. "Breach" points (CPAP settings at which sellar repair was violated) were lowest for the first group. All 3 specimens showed a breach after the first repair technique. For the second repair technique, only a single breach was created in 1 specimen at 20 cm H O. No breaches were created in the third group.
Different skull base repair techniques have varying ability to withstand CPAP. Both second and third repair techniques performed in a nearly similar fashion with regard to their ability to withstand positive pressure ventilation.
尽管最近的阻塞性睡眠呼吸暂停指南建议在内鼻颅底手术后早期使用持续气道正压通气（CPAP），但 CPAP 的启动时间尚不清楚。在这项研究中，我们使用了一种新的、以前经过验证的尸体模型来分析颅底所承受的压力，并评估各种修复技术承受正压的有效性。
在 3 具新鲜人体尸体头部中手术创建颅底缺陷，并使用 3 种常用的修复技术进行修复：（1）Surgicel™ 覆盖物；（2）带硬脑膜密封剂覆盖物的硬脑膜替代品；（3）带硬脑膜密封剂覆盖物的鼻中隔-鼻甲瓣。压力微传感器分别放置在蝶窦和鞍内，分别位于修复物的近端和远端。分析了每种修复技术在不同 CPAP 压力设置（5-20cmH2O）下的有效性。
大约 79%-95%的正压到达蝶窦。三种修复技术的鞍内压力水平差异显著，第三种技术的压力最低。“突破”点（即违反鞍内修复的 CPAP 设置）在第一组中最低。所有 3 个标本在第一次修复技术后均出现突破。对于第二种修复技术，只有 1 个标本在 20cmH2O 时出现单个突破。第三种组未出现突破。
不同的颅底修复技术对 CPAP 的承受能力不同。第二和第三种修复技术在承受正压通气方面的能力相似。
