经鼻蝶入路脑脊液漏修补方法进展

Progress in repair of cerebrospinal fluid leakage via trans-sphenoidal approach

随着显微及内镜技术的发展,经鼻蝶入路可用于前颅底外伤、肿瘤、鞍区占位及三脑室、中上斜坡病变的治疗[1]。经鼻蝶入路的手术切口更小,术后恢复更好;但其造成的前颅底完整性破坏常导致术后脑脊液(CSF)漏的发生。文献报道经鼻蝶入路手术中CSF漏的发生率在15%~30%[2]。前颅底完整性的修补关系到患者的术后恢复;CSF漏作为术后主要的并发症之一,可增加颅内感染的发生率,甚至引起严重的并发症,发生颅内感染后,患者的死亡率高达25%[3]。术中准确发现漏口的位置并行前颅底重建至关重要,自体材料修补作为经典的修补方式,对于较大的复杂的缺损效果欠佳。随着新材料的发现,各类人工材料的使用能应对更加复杂的颅底缺损,可有效减少因术后CSF漏导致的并发症发生率。

With the development of microscopy and endoscopy,a new approach for intracranial tumor surgery has been introduced.Neuro-endoscopic trans-sphenoidal approach can be used for anterior cranial base trauma and tumor,sellar region occupation,third ventricle tumor,middle and upper clivus region and pineal region tumor.While this new approach results in smaller incisions and better postoperative recovery,it also presents a new problem:cerebrospinal fluid(CSF)leakage due to the postoperative disruption of the integrity of the anterior skull base.Due to the popularity of microscopic and endoscopic techniques,this approach has become the development trend of craniocerebral surgery.Therefore,the repair of postoperative CSF leakage is bound to become an ineluctable practical problem in clinical practice for every neurosurgeon who uses endoscopy.The repair of the integrity of the anterior skull base is related to the postoperative recovery of patients.CSF leakage,as one of the major postoperative complications,can increase the probability of intracranial infection and even cause serious complications.In the case of intracranial infection,the mortality rate is up to 25%.Intraoperative accurate detection of leaks in parallel anterior skull base reconstruction is crucial,autograft material repair as the classic way of repair,still less effective for large complex defects,with the discovery of new materials,the use of all kinds of artificial material can deal with more complex base of skull defect,effectively reduce the complications caused by postoperative CSF leakage.