神经内镜下经鼻蝶入路切除鞍区病变的颅底重建效果观察

Effect of skull base reconstruction after resection of sellar lesions under neuroendoscope via nasal sphenoid approach

目的探讨神经内镜下经鼻蝶入路切除鞍区病变的颅底重建的效果。方法回顾性分析韶关市粤北人民医院神经外科2016年11月至2020年6月收治的48例鞍区病变患者的临床资料,其中垂体腺瘤44例,鞍结节脑膜瘤2例,颅咽管瘤2例,所有患者均采用神经内镜下经鼻蝶入路切除鞍区病变,再实施人工硬膜、明胶海绵及生物胶、人工硬膜的"三明治"式修补方法进行颅底重建。观察患者的手术结果及术后随访结果。结果48例患者中病变完全切除者45例,未完全切除者3例,切除率为93.75%;术后46例患者颅底一次修补成功,2例患者出现短暂性的脑脊液鼻漏,其中术后2 d,有1例患者因球囊破裂而发生脑脊液鼻漏,进行二次修补后已经痊愈,术后1个月,有1例患者因打喷嚏而发生无症状性颅内积气和脑脊液鼻漏,再次行颅底重建后已修复;术后所有患者均未出现严重的并发症,术后随访6个月,患者没有出现脑脊液鼻漏的症状,也没有出现新的神经功能缺失。结论神经内镜下经鼻蝶入路切除鞍区病变的三明治式颅底重建能明显减少术后患者脑脊液鼻漏的发生,安全性较高,值得临床推广使用。

Objective To investigate the effect of skull base reconstruction after resection of sellar lesions under neuroendoscope via nasal sphenoid approach.Methods The clinical data of 48 patients with saddle lesions admitted to Department of Neurosurgery,North Guangdong People’s Hospital of Shaoguan City from November 2016 to June2020 were retrospectively analyzed,including 44 cases of pituitary adenomas,2 cases of tuberosity sellar meningioma,2 cases of craniopharyngiomas,All patients underwent neuroendoscopic transnasal transsphenoidal resection of sellar lesions,and then implement the"sandwich"repair method of artificial dura mater,gelatin sponge,biological glue,and artificial dura mater to reconstruct the skull base.The operative results and postoperative follow-up results were observed.Results Among the 48 patients,there were 45 cases of complete resection and 3 cases of incomplete resection,and the resection rate was 93.75%;after the operation,46 patients had a successful repair of the skull base,and 2 patients had transient cerebrospinal fluid rhinorrhea;two days after surgery,one patient had a cerebrospinal fluid rhinorrhea due to the rupture of the balloon,which was cured after the second repair;one month after the operation,one patient suffered from asymptomatic intracranial pneumorrhea and cerebrospinal fluid rhinorrhea due to sneezing,which was repaired after another skull base reconstruction;after the operation,no serious complications occurred in all patients.After a 6 mouths follow-up,the patient had no symptoms of cerebrospinal fluid rhinorrhea and no new neurological deficits.Conclusion Skull base reconstruction after resection of sellar lesions under neuroendoscope via nasal sphenoid approach has a significant effect,can significantly reduce the occurrence of cerebrospinal fluid rhinorrhea in patients after surgery,and is high and worthy of clinical promotion and use.