Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples, Italy.
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples, Italy.
World Neurosurg. 2022 Nov;167:e590-e599. doi: 10.1016/j.wneu.2022.08.059. Epub 2022 Aug 19.
To analyze the long-term fate of autologous fat graft in skull base reconstruction after an extended endoscopic transtuberculum-transplanum approach.
Data from 98 consecutive patients undergoing a transtuberculum-transplanum approach and skull base reconstruction using the 3F technique between June 2017 and January 2022 were retrospectively analyzed. Fat graft volume was measured on postoperative day 1 computed tomography scan and early (≤15 days), 3-month, and 1-year magnetic resonance imaging scans. Fat graft volumes and resorption rate were calculated in patients with a complete radiological follow-up and correlated to demographic, pathological, and surgical features.
Fat volumes and resorption rate were calculated in 55 patients. Mean volume of fat on postoperative day 1 computed tomography scan was 3.58 ± 1.89 cm and on early, 3-month, and 1-year postoperative magnetic resonance imaging scans was 2.45 ± 1.57 cm, 1.40 ± 0.76 cm, and 0.92 ± 0.56 cm, respectively. Resorption rate was 44% after 3 months and 67% after 1 year. Resorption rate did not significantly correlate with demographic, pathological, and surgical features. Cerebrospinal fluid leak requiring redo surgery occurred in 1 patient (1/98, 1.2%). There were 6 cases of visual worsening (6/98, 6.1%); no cases correlated to fat overpacking. No delayed complications at the donor site or at the grafting site were noted.
Autologous fat graft in skull base reconstruction is observed to shrink significantly over time, reaching 67% in 1 year. Its use is associated with excellent outcomes, making it a favored material for skull base reconstruction.
分析经扩大内镜经蝶鞍-颅底入路术后自体脂肪移植在颅底重建中的长期转归。
回顾性分析了 2017 年 6 月至 2022 年 1 月期间，98 例连续接受经蝶鞍-颅底入路和 3F 技术颅底重建的患者的数据。术后第 1 天 CT 扫描测量脂肪移植体积，并在早期（≤15 天）、3 个月和 1 年磁共振成像扫描时测量脂肪移植体积和吸收率。对有完整影像学随访的患者计算脂肪移植体积和吸收率，并与人口统计学、病理学和手术特征相关联。
55 例患者计算了脂肪体积和吸收率。术后第 1 天 CT 扫描时的平均脂肪体积为 3.58±1.89cm，术后早期、3 个月和 1 年磁共振成像扫描时的平均脂肪体积分别为 2.45±1.57cm、1.40±0.76cm 和 0.92±0.56cm。术后 3 个月吸收率为 44%，术后 1 年吸收率为 67%。吸收率与人口统计学、病理学和手术特征无显著相关性。1 例（1/98，1.2%）患者发生需要再次手术的脑脊液漏。6 例（6/98，6.1%）患者出现视力恶化，但无病例与脂肪过度填充有关。未发现供区或移植部位的迟发性并发症。
自体脂肪移植在颅底重建中随时间推移显著缩小，1 年后吸收率达 67%。其应用与良好的结果相关，使其成为颅底重建的首选材料。
