Endoscopic endonasal repair of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles
Endoscopic endonasal repair of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles
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DOI：
10.3171/2009.10.jns08986
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发表时间：
2010-11-01
影响因子：
4.1
通讯作者：
Schwartz, Theodore H.
中科院分区：
文献类型：
--
作者：
Nyquist, Gurston G.;Anand, Vijay K.;Schwartz, Theodore H.
目的。内镜经鼻入路已成为脑脊液漏和前颅底脑膨出修复的首选技术。本研究的目的是确定患者特征；审查围手术期辅助治疗、重建技术和结果；并确定接受内镜鼻内修复前颅底脑脊液漏和脑膨出的患者失败的危险因素。方法。这是一项前瞻性观察性研究，对象为 2004 年 10 月至 2009 年 5 月期间接受内窥镜鼻内脑脊液漏修复术的患者。28 名连续患者接受了 32 次手术。其中 22 名患者是女性，这代表了女性性别的统计显着趋势 (p < 0.05)。平均体重指数（33.9）对肥胖有显着影响。颅底缺损来源包括筛板（9例）、筛中心凹（7例）、筛中心凹/筛板联合（2例）、蝶窦外侧（6例）、蝶鞍（4例）、斜坡（3例）和额窦（1例）。结果。总体鼻内闭合率为 93.8%（32 例手术中的 30 例）。其中一处失败是由于术后清创过度所致，另一处则沿额窦后壁复发，内镜修复可能会闭塞隐窝。结论。内窥镜鼻内入路治疗脑脊液漏和前颅底脑膨出是绝大多数病例的首选修复方法。作者在多个解剖位置的闭合率高达 93.8%，与经颅入路相比毫不逊色，并且与其他内窥镜系列的结果相呼应。 （DOI：10.3171/2009.10.JNS08986）
Object. The endoscopic endonasal approach has become the preferred technique for CSF leak and encephalocele repair of the anterior skull base. The purpose of this study is to identify patient characteristics; review adjunctive perioperative treatments, reconstruction techniques, and outcomes; and identify risk factors for failure in patients undergoing endoscopic endonasal repair of anterior skull base CSF leaks and encephaloceles.Methods. This is a prospective observational study of patients undergoing endoscopic endonasal repair of a CS F leak between October 2004 and May 2009. Twenty-eight consecutive patients underwent 32 procedures. Twenty-two of the patients were women, which represents a statistically significant trend toward the female sex (p < 0.05). The average body mass index (33.9) was significant for obesity. The origin of the skull base defect included the cribriform plate (in 9 cases), fovea ethmoidalis (in 7), combined fovea ethmoidalis/cribriform plate (in 2), lateral sphenoid sinus (in 6), sella (in 4), clivus (in 3), and frontal sinus (in 1).Results. The overall endonasal closure rate was 93.8% (30 of 32 procedures). One failure occurred due to overaggressive postoperative debridement, while the other recurred along the posterior wall of the frontal sinus, and endoscopic repair would have occluded the recess.Conclusions. The endoscopic endonasal approach for the treatment of CSF leaks and encephaloceles of the anterior skull base is the preferred method of repair in the vast majority of cases. The authors' 93.8% closure rate in a variety of anatomical locations compares favorably with the transcranial approach and echoes the results of other endoscopic series. (DOI: 10.3171/2009.10.JNS08986)