蝶窦鞍底黏膜骨瓣翻转术在内镜下经鼻蝶入路手术颅底重建中的应用

Transposition of sellar pedicled-mucoperiostal flap for skull base reconstruction after endoscopic endonasal transsphenoidal surgery

目的探讨蝶窦鞍底黏膜骨瓣翻转术在内镜下经鼻蝶入路手术颅底重建中的方法及应用价值。方法回顾性分析2014年10月至2016年1月在内镜下经鼻蝶入路手术治疗的23例鞍区病变的临床资料,术中均采用蝶窦鞍底黏膜骨瓣翻转术进行颅底重建,即术中在导航引导下确定鞍底粘膜骨瓣的大小,使用磨钻制作骨瓣并向底部翻转,形成半游离的黏膜骨瓣;肿瘤切除后,将半游离的黏膜骨瓣翻转复位,辅以生物蛋白胶固定。结果 23例中,颅咽管瘤1例,鞍上型Rathke囊肿2例,垂体腺瘤20例。术中发生脑脊液漏3例,采用人工材料常规修补后以蝶窦鞍底黏膜骨瓣翻转术。23例术后随访6个月,均未出现脑脊液漏、细菌性脑膜炎和张力性气颅等并发症。结论在内镜下经鼻蝶入路手术中,采用蝶窦鞍底黏膜骨瓣翻转术进行颅底重建中是一种可靠、安全、有效的方法。

Objective To explore the method of transposition of sellar pedicled-mucoperiosteum flap for skull base reconstruction after endoscopic endonasal transsphenoidal surgery(EETS)and its value to the skull base reconstruction.Methods The clinical data of23patients who underwent skull base reconstruction by transposition of sellar pedicled-mucoperiosteum flap after EETS for the tumors or cysts from October,2014to January,2016were analyzed retrospectively.The size of sellar pedicled-mucoperiosteum flap was determined by neuro-navigator-assisted surgery and then semi-free sellar pedicled-mucoperiosteum flap was made by electrical drill and fractured down.After the resection of the tumors or cysts,the semi-free sellar pedicled-mucoperiosteum flaps were transpositioned,and fixed with fibrin glue.Results Of23patients,1had craniopharyngioma,2suprasellar Rathke cysts and20pituitary adenomas.The cerebrospinal fluid leakage happened intraoperatively in3patients,in whom the artificial material was used to repair the leakage and then the transposition of sellar pedicled-mucoperiosteum flap was performed.All the patients were followed up for6months.There were no cerebrospinal fluid leakage,bacterial meningitis,tension pneumocephalus and other complications in all the patients during the following-up.Conclusion The transposition of sellar pedicled-mucoperiosteum flap is a reliable,safe and effective method to reconstruct the skull base after EETS