Lavigne Philippe, Wang Eric W, Gardner Paul A, Snyderman Carl H
Department of Otolaryngology, Centre Hospitalier Universitaire de l'Universite de Montreal, Montreal, Quebec, Canada.
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
J Neurol Surg B Skull Base. 2021 Dec 14;83(4):339-342. doi: 10.1055/a-1680-1870. eCollection 2022 Aug.
Intraoperative cerebrospinal fluid (CSF) leaks are associated with increased risk of postoperative CSF leaks despite multilayered reconstruction with vascularized tissue. A recent randomized controlled trial (RCT) examining the use of perioperative lumbar drains (LD) in high-risk skull base defects identified a significant reduction in postoperative CSF leak incidence (21.2 vs. 8.2%; = 0.017). This study was conducted to assess the efficacy of the selective use of CSF diversion, for patients with intraoperative CSF leaks involving endoscopic endonasal approaches (EEA) to the skull base. Consecutive endoscopic endonasal surgeries of the skull base from a pre-RCT cohort and post-RCT cohort were compared. The following case characteristics between the two cohorts were examined: patient age, body mass index (BMI), rate of revision surgery, tumor histology, use of CSF diversion, and vascularized reconstruction. The primary measured outcome was postoperative CSF leak. The pre-RCT cohort included 76 patients and the post-RCT cohort included 77 patients, with dural defects in either the anterior or posterior cranial fossa (pituitary and parasellar/suprasellar surgeries excluded). There was a significant reduction in the incidence of postoperative CSF leak in the post-RCT cohort (27.6 vs. 12.9%; = 0.04). On subgroup analysis, there was a trend toward improvement in CSF leak rate of the anterior cranial fossa (19.2 vs. 10.5%; = 0.27), whereas CSF leak rates of the posterior cranial fossa were significantly reduced compared with the pre-RCT cohort (41.4 vs. 12.8%; = 0.02). This study demonstrates that the integration of selective CSF diversion into the reconstructive algorithm improved postoperative CSF leak rates.
尽管采用带血管组织进行了多层重建，但术中脑脊液漏与术后脑脊液漏风险增加相关。最近一项关于围手术期腰大池引流（LD）用于高风险颅底缺损的随机对照试验（RCT）发现，术后脑脊液漏发生率显著降低（21.2%对8.2%；P = 0.017）。本研究旨在评估选择性脑脊液分流术对术中脑脊液漏且采用内镜经鼻入路（EEA）至颅底的患者的疗效。比较了RCT前队列和RCT后队列连续的内镜经鼻颅底手术。检查了两个队列之间的以下病例特征：患者年龄、体重指数（BMI）、翻修手术率、肿瘤组织学、脑脊液分流术的使用以及带血管重建。主要测量结果是术后脑脊液漏。RCT前队列包括76例患者，RCT后队列包括77例患者，排除前颅窝或后颅窝硬脑膜缺损（垂体及鞍旁/鞍上手术）。RCT后队列术后脑脊液漏发生率显著降低（27.6%对12.9%；P = 0.04）。亚组分析显示，前颅窝脑脊液漏率有改善趋势（19.2%对10.5%；P = 0.27），而后颅窝脑脊液漏率与RCT前队列相比显著降低（41.4%对12.8%；P = 0.02）。本研究表明，将选择性脑脊液分流术纳入重建方案可提高术后脑脊液漏率。
