颅底硬膜缝合技术在内镜经鼻蝶入路鞍区肿瘤切除中的应用

The application of sellar dural suture technique in endoscopic transsphenoidal sellar region tumors resection.

目的探讨颅底硬膜缝合技术在内镜经鼻蝶入路切除鞍区肿瘤后颅底重建中的可行性和可靠性。方法分析安徽医科大学第一附属医院2019年1月—2021年7月在内镜下经鼻蝶入路切除鞍区肿瘤后采用颅底硬膜缝合技术处理的28例患者临床资料,并进行相关文献复习。结果28例患者均存在术中脑脊液漏(CSFL),参照Esposito分级法,术中发生1级CSFL 14例,2级CSFL 10例,3级CSFL 4例。术中均采用了硬膜缝合技术修补鞍底,27例患者一期颅底重建成功,无术后CSFL发生,1例Rathkes囊肿患者术后出现CSFL,再次接受内镜下CSFL修补术,术后未再出现CSFL。结论颅底缝合硬膜,可以对颅底产生较大的支撑力,重建效果确切,值得临床应用。

Objective To summarize the feasibility and reliability sellar dural suture technique in endoscopic transsphenoidal sellar region tumors resection.Methods Clinical data of 28 patients with sellar region tumors who underwent endoscopic transsphenoidal sellar region tumors resection from January 2019 to July 2021 were analyzed retrospectively.And literature review was also carried out.Results All the 28 patients had intraoperative CSF leakage.According to Kelly grading method,14 cases of Grade 1 CSF leakage,10 cases of Grade 2 CSF leakage and 4 cases of Grade 3 CSF leakage occurred intraoperatively.All cases were accepted the dural suture technique to repair the saddle base.In the last 27 patients,primary skull base reconstruction was successful without postoperative cerebrospinal fluid leakage.One patient with Rathkes cyst had postoperative cerebrospinal fluid leakage,and the endoscopic cerebrospinal fluid leakage repair was performed again and there was no postoperative leakage.Conclusions Suture the dura of the skull base,which can produce a large support force for the skull base,and the reconstruction effect is definite,which is worthy of clinical application.