Snyder Rita, Lee Sungho, Athukuri Prazwal, Ngo Emmeline Monique Tan, Fox Meha Goyal, Fakhri Samer, Takashima Masayoshi, Force Bahar Kapoor, Samson Susan Leanne, Gallagher Kathleen Kelly, Yoshor Daniel, Jalali Ali
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States.
Department of Neurosurgery, Louisiana State University, Shreveport, Luisiana, United States.
J Neurol Surg B Skull Base. 2023 Nov 8;85(Suppl 2):e10-e15. doi: 10.1055/a-2175-8181. eCollection 2024 Oct.
Sellar repair techniques with varying complexity and effectiveness have been employed to reduce the incidence of postoperative cerebrospinal fluid (CSF) leaks following endoscopic transsphenoidal pituitary surgery. This study describes our institutional experience with a minimalistic, highly effective approach to sellar repair. The authors performed a retrospective review of consecutive cases of transsphenoidal pituitary surgery performed at our institution. All included subjects underwent sellar repair with an epidural interlay graft. Relationships between patient and tumor characteristics, incidence of CSF leak, adjunct repair techniques, and endocrine outcomes were examined. Three hundred and thirty-four (334) cases were included. Intraoperative CSF leak was encountered in 116 cases (34.7%), and postoperative CSF leak occurred only once (0.3%) early in the series. Seventy intraoperative CSF leaks were successfully repaired with an epidural interlay alone, including 13 high-flow leaks. Our rate of fat graft use (1.2%), nasoseptal flap (3.0%), and lumbar drain placement (6.6%) in the second half of the series showed a significant decline compared with the first half, indicating increased reliance on the interlay graft over time. Our 65% functional macroadenoma remission rate compares favorably with large historical series. Simple sellar repair using an epidural interlay graft is highly effective in preventing postoperative CSF leaks, including cases of high-flow intraoperative leaks. More complex repair techniques are reserved for select high-risk cases or those with inadequate sellar bony ledges. With this technique, there has been no postoperative CSF leak at our institution in over 300 consecutive transsphenoidal pituitary surgeries.
为降低内镜经蝶窦垂体手术后脑脊液（CSF）漏的发生率，人们采用了各种复杂程度和效果各异的鞍区修复技术。本研究描述了我们采用的一种简约且高效的鞍区修复方法的机构经验。
作者对在我们机构进行的连续经蝶窦垂体手术病例进行了回顾性研究。所有纳入的受试者均采用硬膜外夹层移植进行鞍区修复。研究了患者和肿瘤特征、脑脊液漏发生率、辅助修复技术与内分泌结果之间的关系。
共纳入334例病例。116例（34.7%）术中出现脑脊液漏，在该系列早期，术后脑脊液漏仅发生1次（0.3%）。70例术中脑脊液漏仅通过硬膜外夹层成功修复，其中包括13例高流量漏。与前半部分相比，该系列后半部分我们使用脂肪移植（1.2%）、鼻中隔瓣（3.0%）和腰大池引流（6.6%）的比例显著下降，表明随着时间推移对夹层移植的依赖增加。我们65%的功能性大腺瘤缓解率与大型历史系列相比具有优势。
使用硬膜外夹层移植进行简单的鞍区修复在预防术后脑脊液漏方面非常有效，包括术中高流量漏的病例。更复杂的修复技术则用于特定的高风险病例或鞍区骨质边缘不足的病例。采用这种技术，在我们机构连续300多例经蝶窦垂体手术中没有出现术后脑脊液漏。
