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经鼻内镜切除蝶骨平台和鞍结节脑膜瘤后颅底缺损的封闭

Closure of Skull Base Defects after Endonasal Endoscopic Resection of Planum Sphenoidale and Tuberculum Sellae Meningiomas.

作者信息

Dolci Ricardo Landini Lutaif, Encinas Williams Escalante, Monteiro Amanda André, Kozechen Rickli Jeniffer Cristina, de Souza Jamile Lopes, Todeschini Alexandre Bossi, Padilha Igor Gomes, Zuppani Henrique Bortot, Leite Dos Santos Américo Rubens, Lazarini Paulo Roberto

机构信息

Department of Otolaryngology, Irmandade of Santa Casa de Misericórdia of São Paulo, Brazil.

Faculty of Medical Sciences of Santa Casa of São Paulo, SP, Brazil.

出版信息

Asian J Neurosurg. 2020 Aug 28;15(3):653-659. doi: 10.4103/ajns.AJNS_62_20. eCollection 2020 Jul-Sep.

DOI:10.4103/ajns.AJNS_62_20
PMID:33145222
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7591213/
Abstract

BACKGROUND

The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage.

OBJECTIVE

The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas.

METHODS

A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects.

RESULTS

Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (fungal ball in right frontal sinus and brain abscess). The skull base defect created for resection measured, on average, 3.58 cm.

CONCLUSION

Our experience suggests that closure of skull base defects using combined fascia lata inlay and nasoseptal flap onlay is effective for preventing postoperative CSF leakage in resection of planum sphenoidale and/or tuberculum sellae meningiomas, and offers high reproducibility due to its low cost.

摘要

背景

扩大经鼻内镜经筛板经结节入路可通过微创手术切除肿瘤。手术过程中会造成较大的硬脑膜和骨缺损，增加了术后脑脊液漏的风险。

目的

本研究旨在描述经鼻内镜切除蝶骨平台和/或鞍结节脑膜瘤患者所采用的手术技术及观察到的并发症。

方法

对2013年6月至2018年8月间接受扩大经鼻内镜切除蝶骨平台和/或鞍结节脑膜瘤的患者进行回顾性分析，术中使用自体移植物、阔筋膜镶嵌和鼻中隔瓣覆盖来封闭颅底缺损。

结果

10例患者纳入分析。未报告术后脑脊液漏或脑膜炎病例，而2例患者出现术后感染性并发症（右侧额窦真菌球和脑脓肿）。为切除肿瘤而造成的颅底缺损平均为3.58厘米。

结论

我们的经验表明，联合使用阔筋膜镶嵌和鼻中隔瓣覆盖封闭颅底缺损，对于预防蝶骨平台和/或鞍结节脑膜瘤切除术后脑脊液漏有效，且因其成本低而具有高度可重复性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/def4abece347/AJNS-15-653-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/5bc2a87e0622/AJNS-15-653-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/066af391a126/AJNS-15-653-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/c9d5b2f29070/AJNS-15-653-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/5b25702ddae3/AJNS-15-653-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/6427e6d86d4a/AJNS-15-653-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/9abb84e8b8f9/AJNS-15-653-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/def4abece347/AJNS-15-653-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/5bc2a87e0622/AJNS-15-653-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/066af391a126/AJNS-15-653-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/c9d5b2f29070/AJNS-15-653-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/5b25702ddae3/AJNS-15-653-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/6427e6d86d4a/AJNS-15-653-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/9abb84e8b8f9/AJNS-15-653-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94bd/7591213/def4abece347/AJNS-15-653-g007.jpg

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