Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Int Forum Allergy Rhinol. 2020 Jan;10(1):89-96. doi: 10.1002/alr.22451. Epub 2019 Oct 1.
Achieving an effective endoscopic skull base reconstruction in case of large dural defects requires specific training and can be extremely challenging. The aim of this study was to describe the development and validation of a preclinical model for cerebrospinal fluid (CSF) leak repair, which can be used for training and to test the mechanical efficacy of endoscopic skull base reconstruction.
Eleven fresh-frozen cadaver heads were dissected. A catheter was inserted in the subdural space via a cervical access, which was sealed with mastic; a vertical graduated tube connected to the catheter measured intracranial pressure (ICP), while stained water was injected intracranially. After endoscopic skull base reconstruction was performed, an expert surgeon assessed its efficacy. ICP was then gradually increased until a leak was evident and CSF leak pressure value was recorded. The correlation between subjective and quantitative evaluations was investigated through Pearson and Spearman correlation tests.
The model was successfully tested in 11 specimens. A single, large dural defect was created in each model (transplanum-transtuberculum = 4; transplanum-transtuberculum-transsellar = 3; transclival = 3; transcribriform-transplanum = 1). Skull base reconstruction always comprised a rigid buttress with temporal fascia and/or fat. The CSF leak pressure ranged from 4 to 110 cmH O. The correlation between expert subjective and quantitative assessment of skull base reconstruction mechanical efficacy was high (r = 0.7; r = 0.7; p = 0.010 and p = 0.006, respectively).
This preclinical model is simple, easily reproducible, and effective in simulating an intraoperative leak and objectively measures the CSF leak pressure point of a skull base reconstruction.
在存在大的硬脑膜缺损的情况下实现有效的内镜颅底重建需要特定的培训，并且可能极具挑战性。本研究的目的是描述一种用于脑脊液（CSF）漏修复的临床前模型的开发和验证，该模型可用于培训和测试内镜颅底重建的机械效果。
对 11 个新鲜冷冻的头颅进行解剖。通过颈部入路将导管插入硬脑膜下腔，用乳香密封；一个与导管相连的垂直刻度管测量颅内压（ICP），同时向颅内注入染色水。在完成内镜颅底重建后，由一位专家外科医生评估其效果。然后逐渐增加 ICP，直到出现漏液并记录 CSF 漏压值。通过 Pearson 和 Spearman 相关检验研究主观和定量评估之间的相关性。
该模型在 11 个标本中均成功测试。每个模型均创建了单个大的硬脑膜缺损（经碟鞍-鞍结节=4；经碟鞍-鞍结节-鞍上=3；经斜坡=3；筛板-蝶鞍=1）。颅底重建始终包含颞筋膜和/或脂肪的刚性支撑物。CSF 漏压范围为 4 至 110cmH2O。专家对颅底重建机械效果的主观和定量评估之间的相关性很高（r=0.7；r=0.7；p=0.010 和 p=0.006）。
该临床前模型简单、易于重现，可有效模拟术中漏液，并客观测量颅底重建的 CSF 漏压点。
