Alanazi Khalid M, Alghamdi Abdulaziz M, Ghazal Faisal H, AlQurashi Faisal S, Alqerafi Ahmed Abdulaziz, Alghamdi Khalid Talal, Algahtani Abdulhadi Y
College of Medicine, Jouf University, Sakaka, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
Surg Neurol Int. 2024 Aug 2;15:272. doi: 10.25259/SNI_331_2024. eCollection 2024.
Over the past two decades, endoscopic endonasal skull base surgery (EESBS) has revolutionized the treatment of skull base tumors by enabling minimal access to resect significant pathologies such as meningiomas, pituitary adenomas, and chordomas. Despite its efficacy, complications such as cerebrospinal fluid (CSF) leak pose significant challenges, with an average incidence of 8.9% following EESBS. Therefore, our study aims to investigate the risk factors associated with postoperative CSF leak after employing an endoscopic endonasal approach for skull base surgery, focusing on patients treated at King Abdul-Aziz Medical City in Jeddah and King Abdullah Medical City in Makkah, Saudi Arabia.
A retrospective review of patients who underwent an endoscopic endonasal approach for the resection of intradural skull base pathology between January 2016 and December 2022 was performed with a total of 51 patients. Basic demographic data were collected, along with patient comorbidities, presenting symptoms, tumor pathology, tumor site, the extent of resection, and outcomes.
51 participants were analyzed, with a mean age of 43.41. Male participants comprised (58.8%), while headaches were the most common symptom (74.5%), followed by visual disturbances (51.0%). Nonsecretory tumors predominated, primarily located in the sellar and suprasellar regions (58.8%). Gross total resection was performed in the majority (56.9%), with a 9.8% incidence of postoperative CSF leak. Notably, all four patients with CSF leak experienced preoperative headaches. Hypertension was prevalent in Cases 1 and 4, with Case 4 having a history of neurological disease and radiation therapy. Anterior skull base tumors were most frequent in Cases 3 and 4.
The incidence of CSF leakage after surgery in this study was similar to that previously reported. It is worth noting that repeated surgeries may increase the risk of postoperative CSF leakage. Therefore, it is important to carefully evaluate the surgical approach for tumor removal and skull base reconstruction, considering the tumor characteristics and the patient's overall condition.
在过去二十年中，鼻内镜下经鼻颅底手术（EESBS）通过实现微创切除诸如脑膜瘤、垂体腺瘤和脊索瘤等重大病变，彻底改变了颅底肿瘤的治疗方式。尽管其疗效显著，但诸如脑脊液（CSF）漏等并发症带来了重大挑战，EESBS术后平均发生率为8.9%。因此，我们的研究旨在调查采用鼻内镜下经鼻入路进行颅底手术后与术后脑脊液漏相关的危险因素，重点关注沙特阿拉伯吉达的阿卜杜勒 - 阿齐兹国王医疗城和麦加的阿卜杜拉国王医疗城接受治疗的患者。
对2016年1月至2022年12月期间接受鼻内镜下经鼻入路切除硬膜内颅底病变的患者进行回顾性研究，共51例患者。收集了基本人口统计学数据，以及患者的合并症、症状表现、肿瘤病理、肿瘤部位、切除范围和结果。
对51名参与者进行了分析，平均年龄为43.41岁。男性参与者占（58.8%），而头痛是最常见的症状（74.5%），其次是视力障碍（51.0%）。非分泌性肿瘤占主导，主要位于鞍区和鞍上区（58.8%）。大多数患者（56.9%）进行了全切，术后脑脊液漏发生率为9.8%。值得注意的是，所有四名脑脊液漏患者术前均有头痛症状。病例1和病例4中高血压较为普遍，病例4有神经疾病和放疗史。病例3和病例4中前颅底肿瘤最为常见。
本研究中手术后脑脊液漏的发生率与先前报道的相似。值得注意的是，重复手术可能会增加术后脑脊液漏的风险。因此，考虑肿瘤特征和患者整体状况，仔细评估肿瘤切除和颅底重建的手术方法非常重要。
