Fraioli B, Pastore F S, Floris R, Vagnozzi R, Simonetti G, Liccardo G, Giuffrè R
Institute of Neurosurgery, University of Rome Tor Vergata, Italy.
Surg Neurol. 1997 Oct;48(4):409-12; discussion 412-3. doi: 10.1016/s0090-3019(97)80465-x.
Cerebrospinal fluid (CSF) fistula represents a fearful complication of transsphenoidal surgery and, despite careful intraoperative repair and prolonged postoperative lumbar CSF drainage, need for a new surgical intrasphenoidal plasty is not uncommon.
These cases prompted us to develop a simple, minimally invasive, harmless repeatable technique consisting of a computed tomography (CT)-guided intrasphenoidal injection of fibrin glue through a 12-gauge spinal needle.
Five patients presenting with rhinoliquorrhea following a transsphenoidal approach for the excision of pituitary adenomas (three cases) and craniopharyngiomas (two cases) were treated successfully with the presented technique. In two cases the first attempt attained only partial success and therefore the procedure was repeated. In the last two cases, the injection of fibrin glue was preceded by 2 cc of fresh autologous blood, with the aim of enhancing the mechanisms of healing, possibly inducing adhesions and fibrosis.
The proposed method of treatment for CSF leakage following transsphenoidal surgery may represent a valid alternative to the surgical option.
脑脊液漏是经蝶窦手术可怕的并发症，尽管术中仔细修补且术后长时间行腰大池脑脊液引流，但仍常有必要再次行蝶窦内成形术。
这些病例促使我们开发一种简单、微创、无害且可重复的技术，即通过12号脊髓穿刺针在计算机断层扫描（CT）引导下经蝶窦内注射纤维蛋白胶。
5例经蝶窦入路切除垂体腺瘤（3例）和颅咽管瘤（2例）后出现鼻漏的患者，采用本技术成功治愈。2例首次尝试仅部分成功，因此重复了该操作。在最后2例中，在注射纤维蛋白胶之前先注入2毫升新鲜自体血，目的是增强愈合机制，可能诱导粘连和纤维化。
所提出的经蝶窦手术后脑脊液漏的治疗方法可能是手术选择的有效替代方案。
