胶原海绵人工脑膜在癫痫Ⅱ期手术脑脊液漏防治中的应用

Application of collagen sponge as an artificial dura mater in epilepsy surgery after invasive monitoring to prevent cerebrospinal fluid leakage

目的分析胶原海绵人工脑膜用于癫痫Ⅱ期手术防治脑脊液漏时的不同使用方法和疗效。方法收集自2009年1月至2012年6月在上海仁济医院癫痫诊疗中心接受侵袭性颅内电极监测及Ⅱ期手术的癫痫患者共49例进行回顾性分析。49例患者Ⅱ期手术中均采用胶原海绵人工脑膜修复缺损硬膜和防治脑脊液漏，并根据硬膜修复方式分为2组：A组（22例）采用硬膜外人工脑膜修复方式，B组（27例）采用硬膜下人工脑膜修复方式。另取同期未使用人工脑膜等修补材料的同类手术患者15例作为对照组（C组1。结果A组5例、B组2例、C组5例术后发生脑脊液漏和皮下积液，发生率分别为22．7％、7．4％、33.3％，差异有统计学意义（P〈0．05）。脑脊液漏及皮下积液患者均给予皮下穿刺抽液后加压包扎。A组2例、C组3例因持续性脑脊液漏及皮下积液，行腰大池持续引流后症状好转。结论硬膜下人工脑膜修复方式相比硬膜外修复方式更能有效地降低癫痫Ⅱ期手术后脑脊液漏的发生率。

Objective To analyze the effect of collagen sponge as an artificial dura mater on repairing dural defects and preventing cerebrospinal fluid （CSF） leakage during epilepsy surgery after invasive intracranial electrode monitoring. Methods A total of 64 patients who underwent epilepsy surgery after invasive intracranial electrode monitoring in our hospital from January 2009 and June 2012 were involved in this study. Forty-nine patients were divided into two groups according to the methods using dural substitute for the closure of dural defects. Group A consisted of 22 patients, whose dural substitutes were placed on the dural defect after the dura mater was sutured. Group B consisted of 27 patients, whose dural substitutes were used subdurally before the dura mater was sutured. As a control group （group C）, there were 15 patients undergoing similar epilepsy surgery without using artificial substitutes. Results Five patients from group C （33.3%） had the postoperative complication of CSF leakage and subsequent accumulative liquid under scalp flap, whereas 5 patients were found in group A （22.7%） and 2 patients in group B （7.4%） with significant difference （P〈0.05）. All patients were treated by compression bandaging after manual drainage. Two patients in group A and three patients in group C were cured by closed continuous drainage of CSF via lumber subarachnoid catheter. Conclusions Using collagen sponge as an artificial substitute during epilepsy surgery can reconstruct the integrity of dura mater and reduce the incidence of CSF leakage. Artificial dura mater used subdurally is more effective than that used extradurally in preventing CSF leakage.