Totten Douglas J, Manzoor Nauman F, Yancey Kristen L, Yawn Robert J, Haynes David S, Rivas Alejandro
Vanderbilt University School of Medicine, Nashville, Tennessee, United States.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
J Neurol Surg B Skull Base. 2021 Mar 12;82(6):695-699. doi: 10.1055/s-0040-1713772. eCollection 2021 Dec.
To compare the use of porcine small intestinal submucosal grafts (SISG) and standard autologous material (fascia) in prevention of cerebrospinal fluid (CSF) leak and pseudomeningocele formation after translabyrinthine resection. Set at the tertiary skull base center. This is a retrospective chart review. After Institutional Review Board approval, we performed a retrospective cohort study evaluating CSF leak in patients who underwent resection of lateral skull base defects with multilayered reconstruction using either fascia autograft or porcine SISGs. Demographics were summarized with descriptive statistics. Logistic regression was used to compare autograft and xenograft cohorts in terms of CSF complications. Seventy-seven patients underwent lateral skull base resection, followed by reconstruction of the posterior cranial fossa. Of these patients, 21 (27.3%) underwent multilayer repair using SISG xenograft. There were no significant differences in leak-associated complications between autograft and xenograft cohorts. Ventriculoperitoneal shunt was necessary in one (1.8%) autograft and one (4.8) xenograft cases ( = 0.49). Operative repair to revise surgical defect was necessary in three (5.4%) autograft cases and none in xenograft cases. The use of SISG as a component of complex skull base reconstruction after translabyrinthine tumor resection may help reduce CSF leak rates and need for further intervention.
比较猪小肠黏膜下层移植物（SISG）和标准自体材料（筋膜）在经迷路切除术后预防脑脊液（CSF）漏和假性脑膜膨出形成中的应用。研究地点为三级颅底中心。这是一项回顾性图表审查。经机构审查委员会批准后，我们进行了一项回顾性队列研究，评估接受多层重建（使用自体筋膜移植或猪SISG）修复外侧颅底缺损的患者的脑脊液漏情况。人口统计学数据用描述性统计进行总结。使用逻辑回归比较自体移植组和异种移植组在脑脊液相关并发症方面的情况。77例患者接受了外侧颅底切除术，随后进行了后颅窝重建。其中，21例（27.3%）患者使用SISG异种移植物进行了多层修复。自体移植组和异种移植组在与漏相关的并发症方面无显著差异。自体移植组有1例（1.8%）和异种移植组有1例（4.8%）需要进行脑室腹腔分流术（P = 0.49）。自体移植组有3例（5.4%）需要进行手术修复以修正手术缺损，而异种移植组无此情况。在经迷路肿瘤切除术后，使用SISG作为复杂颅底重建的一个组成部分可能有助于降低脑脊液漏发生率以及减少进一步干预的必要性。
