Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery
Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery
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DOI：
10.3171/2018.4.jns18366
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发表时间：
2019-11-01
影响因子：
4.1
通讯作者：
Wakabayashi, Toshihiko
中科院分区：
文献类型：
--
作者：
Ishikawa, Takayuki;Takeuchi, Kazuhito;Wakabayashi, Toshihiko
目的经蝶窦手术是前颅底手术的常用方法，尤其是鞍区手术。然而，由于其解剖位置，脑脊液漏是该方法的主要并发症。作者于2013年介绍了一种新的前颅底手术分级重建策略，并进行了连续硬膜切除。在这篇论文中，作者报告了他们的方法和结果。方法回顾性识别了2013年4月至2017年3月期间在名古屋大学医院和几家合作医院由单一神经外科医生使用TSS或扩展TSS切除的鞍区或前颅底病变的所有患者。结果176例TSS（常规TSS 141例，扩大内镜TSS 35例），76例为Esposito 2 ~ 3级硬膜内高流量脑脊液漏。高流量脑脊液漏组术后发生脑脊液漏3例。术后脑脊液漏2级和3级的发生率分别为2.9%（1/ 34）和4.7%（2/42）。使用这种方法，可以减少需要鼻中隔皮瓣和腰椎引流的病例的频率。
OBJECTIVE Transsphenoidal surgery (TSS) is commonly used for anterior skull base surgery, especially in the sella turcica (sellar) region. However, because of its anatomical position, CSF leakage is a major complication of this approach. The authors introduced a new grading reconstruction strategy for anterior skull base surgery with continuous dural suturing in 2013. In this paper the authors report on their methods and results.METHODS All patients with sellar or anterior skull base lesions that were removed with TSS or extended TSS by a single neurosurgeon between April 2013 and March 2017 at Nagoya University Hospital and several cooperating hospitals were retrospectively identified. Three methods of suturing dura were considered, depending on the dural defect.RESULTS There were 176 TSS cases (141 conventional TSS cases and 35 extended endoscopic TSS cases) and 76 cases of Esposito's grade 2 or 3 intradural high-flow CSF leakage. In the high-flow CSF leak group, there were 3 cases of CSF leakage after the operation. The rates of CSF leakage after surgery corresponding to grades 2 and 3 were 2.9% (1/ 34) and 4.7% (2/42), respectively.CONCLUSIONS Dural suturing is a basic and key method for reconstruction of the skull base, and continuous suturing is the most effective approach. Using this approach, the frequency of cases requiring a nasoseptal flap and lumbar drainage can be reduced.