Department of Neurosurgery, Nagoya University Graduate School of Medicine.
Neurol Med Chir (Tokyo). 2022 Apr 15;62(4):203-208. doi: 10.2176/jns-nmc.2021-0355. Epub 2022 Mar 16.
Extended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, secure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Although collagen matrix has been applied for dural reconstruction in neurosurgery, its suitability for application in extended eTSS remains unclear. Eighteen patients underwent modified shoelace dural closure using collagen matrix after lesionectomy via extended eTSS. In this technique, a collagen matrix, which was placed subdurally (inlay graft), was continuously sutured with both open dural edges like a shoelace. Then, another collagen matrix was placed epidurally (onlay graft), and rigid reconstruction was performed using the septal bone and a resorbable fixation mesh. Postoperative CSF leakage did not occur in 17 patients but did occur in 1 patient with tuberculum sellae meningioma. In this case, the CSF leakage point was detected just around the area between the coagulated dura and the adjacent collagen matrix. The collagen matrix harvested from this area was pathologically examined; neovascularization and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, neovascularization and fibroblast infiltration into the collagen matrix were apparent on the surface of the collagen matrix harvested from the non-CSF leakage area. Our novel dural closure technique using collagen matrix could be an effective option for sellar reconstruction in extended eTSS; however, it should be applied in patients in whom normal dural edges are preserved.
经鼻内镜扩大经蝶窦手术（eTSS）为各种鞍旁病变提供了广阔的手术视野；然而，术中高流量脑脊液（CSF）漏是不可避免的。因此，安全的鞍底重建方法对于预防术后 CSF 漏至关重要。尽管胶原基质已应用于神经外科硬脑膜重建，但它在扩大 eTSS 中的适用性尚不清楚。18 例患者在通过扩大 eTSS 切除病变后，采用胶原基质进行改良鞋带式硬脑膜缝合。在该技术中，将胶原基质置于硬脑膜下（嵌入式移植物），与开放硬脑膜边缘像鞋带一样连续缝合。然后，将另一个胶原基质置于硬脑膜外（覆盖性移植物），使用鼻中隔骨和可吸收固定网进行刚性重建。17 例患者术后无 CSF 漏，但 1 例鞍结节脑膜瘤患者发生 CSF 漏。在这种情况下，CSF 漏点仅在凝固硬脑膜和相邻胶原基质之间的区域附近检测到。从该区域采集的胶原基质进行了病理检查；未检测到新生血管形成和纤维母细胞浸润到胶原基质中。另一方面，在非 CSF 漏区域采集的胶原基质表面，明显有新生血管形成和纤维母细胞浸润到胶原基质中。我们使用胶原基质的新型硬脑膜缝合技术可能是扩大 eTSS 中鞍底重建的有效选择；然而，它应该应用于硬脑膜边缘正常的患者。
