Kabuto M, Kubota T, Kobayashi H, Takeuchi H, Nakagawa T, Kitai R, Kodera T, Kawai H, Arishima H
Department of Neurosurgery, Fukui Medical School, Japan.
J Neurosurg. 1998 Jun;88(6):949-53. doi: 10.3171/jns.1998.88.6.0949.
The authors have used a silicone plate for reconstruction of the sellar floor during rhinoseptoplastic transsphenoidal surgery because it has greater elasticity and is easier to carve than nasal septal cartilage and sphenoid sinus bone. This study was designed to evaluate the usefulness of this technique based on the authors' experience during the past 7.6 years.
A silicone plate was used to reconstruct the sellar floor in 69 consecutive patients with sellar tumors that included 60 pituitary adenomas and nine Rathke's cleft cysts. The patients ranged in age from 16 to 82 years (mean 52 years). The postoperative position of the silicone plate could be clearly identified on sagittal or coronal magnetic resonance (MR) imaging as a very low intensity plate (void signal). No displacement or migration of the implanted silicone plate was observed on follow-up MR imaging in any patient. Infections of the lesion such as a pituitary abscess were not observed clinically or radiologically in any patient. Of the 16 patients with intraoperative cerebrospinal fluid (CSF) leakage, only one patient who had a ghost sella developed postoperative CSF rhinorrhea. In all seven patients who underwent repeated surgery for residual or recurrent tumor, the silicone plate that had been placed at the initial procedure was covered with a relatively thin fibrous capsule and the plate was well preserved. The silicone plate was easily removed at reoperation and was useful for detection of the sellar floor window made previously.
These results indicate that a silicone plate can be useful for reconstruction of the sellar floor in rhinoseptoplastic transsphenoidal surgery.
作者在鼻中隔成形经蝶窦手术中使用硅胶板重建鞍底，因为它比鼻中隔软骨和蝶窦骨具有更大的弹性，且更容易雕刻。本研究旨在根据作者过去7.6年的经验评估该技术的实用性。
连续69例鞍区肿瘤患者使用硅胶板重建鞍底，其中包括60例垂体腺瘤和9例拉克氏囊肿。患者年龄在16至82岁之间（平均52岁）。硅胶板术后位置在矢状位或冠状位磁共振成像上可清晰识别为极低强度板（无信号）。随访磁共振成像未观察到任何患者植入的硅胶板有移位或迁移。任何患者在临床或影像学上均未观察到病变感染，如垂体脓肿。16例术中发生脑脊液漏的患者中，只有1例空蝶鞍患者术后出现脑脊液鼻漏。在所有7例因残留或复发肿瘤接受再次手术的患者中，初次手术时放置的硅胶板被一层相对较薄的纤维包膜覆盖，且硅胶板保存良好。再次手术时硅胶板很容易取出，有助于发现先前制作的鞍底窗口。
这些结果表明硅胶板在鼻中隔成形经蝶窦手术中重建鞍底可能有用。
