在纠正眶距增宽症中伴有脑脊液漏的大型硬脑膜缺损的处理
Management of Large Dural Defect with CSF Leak in Hypertelorism Correction.
作者信息
Balaji S M, Ganesh C V Shankar, Balaji Preetha
机构信息
Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.
Department of Neurosurgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.
出版信息
Ann Maxillofac Surg. 2021 Jan-Jun;11(1):136-139. doi: 10.4103/ams.ams_43_21. Epub 2021 Jul 24.
THE RATIONALE
Dural tear is a serious complication during hypertelorism corrective surgeries. Identifying the tear and managing requires considerable expertise. Managing large dural tears correctly is necessary to prevent cerebrospinal fluid (CSF)-related complications in craniofacial surgery.
PATIENT CONCERNS
The patient presented with hypertelorism as a part of the Tessier Cleft 0 and sought to correct the widely placed eyes.
DIAGNOSIS
Large critical-sized dural tear during modified box osteotomy surgery.
TREATMENT
Besides successful modified box osteotomy surgery, the critical-sized dural tear was managed with fascia lata and fibrin glue.
OUTCOMES
There was no CSF leak or related complication postsurgically indicating successful sealing and healing of the dural tear.
TAKE-AWAY LESSONS: The synergistic mechanism by which fascia lata graft and fibrin glue help to hermetically seal the critical-sized defect, especially when there are variable amounts of hydrostatic-hydrodynamic forces of CSF exerting pressure on the patched area, is discussed.
理论依据
硬膜撕裂是眶距增宽矫正手术中的一种严重并发症。识别和处理这种撕裂需要相当专业的知识。正确处理大的硬膜撕裂对于预防颅面外科手术中与脑脊液（CSF）相关的并发症至关重要。
患者情况
该患者患有作为Tessier 0型腭裂一部分的眶距增宽，并寻求矫正眼距过宽的问题。
诊断
改良盒状截骨手术期间出现大的临界尺寸硬膜撕裂。
治疗
除了成功进行改良盒状截骨手术外，临界尺寸的硬膜撕裂采用阔筋膜和纤维蛋白胶进行处理。
结果
术后没有脑脊液漏或相关并发症，表明硬膜撕裂成功封闭和愈合。
经验教训
讨论了阔筋膜移植和纤维蛋白胶帮助紧密封闭临界尺寸缺损的协同机制，尤其是当脑脊液的静水压 - 流体动力对修补区域施加不同程度压力时。
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