Wang Runfeng, Zhou Gaoyang, Wang Jin, Ma Bo, Wang Ping, Gao Guodong, Sun Shukai, Zhang Zhiguo
Department of Neurosurgery, Tangdu Hospital, The Air Force Military Medical University, Xi'an, Shaanxi, China.
Front Oncol. 2023 Aug 2;13:1224804. doi: 10.3389/fonc.2023.1224804. eCollection 2023.
Transsphenoidal secondary operations are a minority but not a rare occurrence. How to viably prevent cerebral fluid (CSF)-related complications and confine surgery-caused injury in secondary surgery as minimally as possible is a huge challenge. This article shares our solution of recycling a prior Hadad-Bassagasteguy flap (HBF) along with a using small piece of free autologous mucosa to reconstruct the skull base.
Of 69 patients, fitted criteria were assigned into 2 different groups: a recycled HBF incorporated with an autologous free mucosa and a recycled HBF incorporated with an artificial dura to rebuild the skull base in secondary transsphenoidal surgery. The postoperative morbidities of pseudomeningocele, CSF leakage and meningitis were recorded and analyzed.
A recycled HBF incorporated with an autologous mucosa is capable of reducing CSF complications compared to that of the matched group, particularly decreasing the morbidity of meningitis in secondary transsphenoidal surgery. Diabetes mellitus, craniopharyngioma, chordoma and the utilization of artificial dura were independent risk factors for CSF complications in secondary transsphenoidal surgery through univariate and multivariate logistic regression. In addition, diabetes mellitus and artificial dura are more likely to induce CSF leakage and meningitis. Patients suffering from craniopharyngioma are more susceptible to meningitis. Chordoma indiscriminately increased the risk of each CSF complication.
A recycled HBF incorporated with an autologous mucosa is reliable for reconstructing the skull base in secondary transsphenoidal surgery, especially for patients simultaneously suffering from diabetes mellitus and central skull base tumors.
经蝶窦二次手术虽占少数但并不罕见。如何切实预防脑脊液（CSF）相关并发症，并在二次手术中尽可能减少手术造成的损伤，是一项巨大挑战。本文分享我们利用先前的哈达德 - 巴萨加斯特盖皮瓣（HBF）并联合一小片自体游离黏膜来重建颅底的解决方案。
69例符合标准的患者被分为2组：一组在经蝶窦二次手术中采用回收的HBF联合自体游离黏膜重建颅底，另一组采用回收的HBF联合人工硬脑膜重建颅底。记录并分析术后假性脑膜膨出、脑脊液漏和脑膜炎的发病率。
与匹配组相比，回收的HBF联合自体黏膜能够减少脑脊液相关并发症，尤其能降低经蝶窦二次手术中脑膜炎的发病率。通过单因素和多因素逻辑回归分析，糖尿病、颅咽管瘤、脊索瘤以及人工硬脑膜的使用是经蝶窦二次手术中脑脊液相关并发症的独立危险因素。此外，糖尿病和人工硬脑膜更易引发脑脊液漏和脑膜炎。患有颅咽管瘤的患者更容易患脑膜炎。脊索瘤会无差别地增加每种脑脊液相关并发症的风险。
回收的HBF联合自体黏膜在经蝶窦二次手术中重建颅底是可靠的，尤其适用于同时患有糖尿病和中央颅底肿瘤的患者。
