Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy.
Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy.
PLoS One. 2021 Mar 15;16(3):e0245119. doi: 10.1371/journal.pone.0245119. eCollection 2021.
Post-operative CSF leak still represents the main drawback of Endoscopic Endonasal Approach (EEA), and different reconstructive strategies have been proposed in order to decrease its rate.
To critically analyze the effectiveness of different adopted reconstruction strategies in patients that underwent EEA.
Adult patients with skull base tumor surgically treated with EEA were retrospectively analyzed. Data recorded for each case concerned patient demographics, type of surgical approach, histotype, anatomical site of surgical approach, intra-operative CSF leak grade (no leak (INL), low flow (ILFL), high flow (IHFL)), reconstructive adopted strategy, Lumbar Drain positioning, post-operative CSF leak rate and intra/post-operative complications.
A total number of 521 patients (January 2012-December 2019) was included. Intra-operative CSF leak grade showed to be associated with post-operative CSF leak rate. In particular, the risk to observe a post-operative CSF leak was higher when IHFL was encountered (25,5%; Exp(B) 16.25). In particular, vascularized multilayered reconstruction and fat use showed to be effective in lowering post-operative CSF leaks in IHFL (p 0.02). No differences were found considering INL and ILFL groups. Yearly post-operative CSF leak rate analysis showed a significative decreasing trend.
Intra-operative CSF leak grade strongly affected post-operative CSF leak rate. Multilayer reconstruction with fat and naso-septal flap could reduce the rate of CSF leak in high risk patients. Reconstructive strategies should be tailored according also to the type and the anatomical site of the approach.
内镜经鼻入路（EEA）术后脑脊液漏仍然是主要的缺点，已经提出了不同的重建策略来降低其发生率。
分析 EEA 患者采用不同重建策略的效果。
回顾性分析接受 EEA 手术治疗的颅底肿瘤的成年患者。为每个病例记录的数据包括患者人口统计学、手术方法类型、组织学类型、手术入路解剖部位、术中脑脊液漏分级（无漏（INL）、低流量（ILFL）、高流量（IHFL））、采用的重建策略、腰大池引流定位、术后脑脊液漏率以及围手术期并发症。
共纳入 521 例患者（2012 年 1 月至 2019 年 12 月）。术中脑脊液漏分级与术后脑脊液漏率相关。当遇到 IHFL 时，发生术后脑脊液漏的风险更高（25.5%；Exp(B) 16.25）。特别是血管化多层重建和脂肪的使用可以降低 IHFL 患者术后脑脊液漏的发生率（p 0.02）。在 INL 和 ILFL 组之间没有发现差异。每年术后脑脊液漏率分析显示出明显的下降趋势。
术中脑脊液漏分级强烈影响术后脑脊液漏率。脂肪和鼻中隔瓣的多层重建可以降低高危患者脑脊液漏的发生率。重建策略还应根据手术类型和入路解剖部位进行调整。
