Skull Base Dural Repair Using Autologous Fat as a Dural Substitute: An Efficient Technique
Skull Base Dural Repair Using Autologous Fat as a Dural Substitute: An Efficient Technique
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DOI：
10.1016/j.wneu.2019.03.293
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发表时间：
2019-07-01
影响因子：
2
通讯作者：
Ohata, Kenji
中科院分区：
文献类型：
--
作者：
Bohoun, Christian A.;Goto, Takeo;Ohata, Kenji
背景：颅底入路的硬脑膜修复仍然具有挑战性，尤其是在存在严重缺陷的情况下。自体脂肪已经成为以前使用的各种替代材料的替代品。方法：回顾近5年来71例因颅底病变行自体脂肪替代硬脑膜修复重要硬脑膜缺损的手术病例。从腹部或大腿取出的移植物被压平并应用于缺损处。结果：主要病理类型为神经鞘瘤(45%)和脑膜瘤(35.21%)，无副作用。手术入路包括经髁窝入路、枕下入路和额颞入路。硬脑膜缺损主要位于后颅窝(73.2%)和中颅窝(25.4%)。未发生与采集部位相关的并发症。7例术后8天~2个月一过性皮下积液自行吸收。术后无脑脊液外漏、感染等并发症发生。结论：在颅底入路中，使用自体脂肪作为硬脑膜替代物可有效、持久地修复硬脑膜，即使在扩大的缺损情况下也是如此。脂肪移植物的观察特性和所取得的效果使其成为理想的硬脑膜替代物。
BACKGROUND: Dural repair during skull base approaches remains challenging, especially in the presence of significant defects. The autologous fat has become an alternative to various substitute materials being used previously. We report here our experience and technique for the repair of notable skull base dural defects using autologous fat as a dural substitute.METHODS: Over a period of 5 years, 71 consecutive patients operated on for skull base pathologies with an important intraoperative dural defect repaired using autologous fat tissue as replacement material were reviewed. The graft, withdrawn from the abdomen or thigh, was flattened and applied to the defect. The clinical findings and outcomes were assessed.RESULTS: Main pathologies included schwannomas (45%) and meningiomas (35.21%), with no side predilection. Surgical approaches such as transcondylar fossa, suboccipital, and frontotemporal approaches were used. Dural defects were mainly located in the posterior (73.2%) and middle cranial fossae (25.4%). No harvesting site-related complication occurred. In 7 cases, transitory subcutaneous fluid collection spontaneously resorbing after 8 days to 2 months was observed. No external cerebrospinal fluid leakage, infection, or other complication was noted during the following period.CONCLUSIONS: Dural repair can be effectively and durably achieved using autologous fat graft as a dural substitute during skull base approaches, even in cases of extended defects. The observed characteristics of the fat graft along with the achieved outcome make it an ideal dural substitute.