硬脑膜连续缝合技术在神经内镜经鼻手术切除颅内肿瘤后高流量脑脊液漏修补中的作用

Therapeutic effect of transnasal endoscopic continuous dural suturing for closure of high-flow cerebrospinal fluid leakage post intracranial tumor resection

目的探讨硬脑膜连续缝合技术在神经内镜扩大经鼻手术切除颅内肿瘤后高流量脑脊液漏修补中的作用。方法回顾性分析2018年7月至2020年1月郑州大学第一附属医院神经外科采用神经内镜扩大经鼻手术切除颅内肿瘤患者的临床资料,共106例。所有患者术中均发生高流量脑脊液漏(Esposito分级3级),其中48例重建颅底过程中联合应用硬脑膜连续缝合技术(硬脑膜缝合组),58例未联合硬脑膜连续缝合技术(硬脑膜未缝合组)。比较两组患者脑脊液漏的修补时间、术后脑脊液漏和其他并发症的发生情况。结果硬脑膜缝合组脑脊液漏的修补时间为(63.0±7.5)min,与硬脑膜未缝合组的(31.0±6.2)min比较,差异有统计学意义(P<0.01)。术后硬脑膜缝合组与硬脑膜未缝合组分别有2.1%(1/48)和19.0%(11/58)的患者发生脑脊液漏,差异有统计学意义(P<0.05);分别有4.2%(2/48)和8.6%(5/58)的患者发生颅内感染,差异无统计学意义(P=0.599)。术后行腰大池引流术、第2次脑脊液漏修补术及发生严重水电解紊乱的比率,两组比较差异均无统计学意义(均P>0.05)。106例患者的随访时间为6~12个月,12例术后发生脑脊液漏的患者中,硬脑膜未缝合组中的1例复发颅咽管瘤患者因下丘脑反应和颅内感染死亡,其余患者预后良好。结论经鼻神经内镜硬脑膜连续缝合技术修补颅内肿瘤切除术后高流量脑脊液漏虽然延长了手术时间,但可有效降低术后脑脊液漏的发生率,且不增加相关并发症的发生率。

Objective To evaluate the effect of transnasal endoscopic continuous dural suturing for closure of high-flow cerebrospinal fluid(CSF)leakage post intracranial tumor resection.Methods A retrospective study was conducted on the clinical data of 106 patients who underwent transnasal endoscopic resection of intracranial tumors from July 2018 to January 2020 at Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University.All patients developed interoperative high-flow CSF leakage(Esposito grade 3)during operation.Among them,continuous dural suturing was performed for closure of CSF leakage in 48 patients who were categorized into the suturing group,while continuous dural suturing was not performed in 58 patients who were divided into the non-suturing group.The time spent in closure of CSF leakage,occurrence of postoperative CSF leakage and other complications were compared between the two groups.Results The time spent for closure of CSF leakage in the suturing group was longer than that in the non-suturing group(63.0±7.5 min vs.31.0±6.2 min),and the difference was significant(P<0.01).2.1%(1/48)in the suturing group developed postoperative CSF leakage,and the proportion was significantly lower than that in the non-suturing group in which 19.0%(11/58)reported postoperative CSF leakage(P<0.05).There were 4.2%(2/48)of intracranial infection in the suturing group and 8.6%(5/58)of intracranial infection in the non-suturing group.The difference was not significant(P=0.599).There was no significant difference in the rate of lumbar drainage,second operation or the incidence of severe electrolyte disturbance between the two groups(all P>0.05).The follow-up duration was 6-12 months.Among 12 patients developing postoperative CSF leakage,one patient in the non-suturing group had recurrent craniopharyngioma and died because of severe hypothalamic syndrome and intracranial infection,and the remaining 11 patients reported favorable outcomes.Conclusion The technique of transnasal endoscopic continuous dural suturing for closure of high-flow CSF leakage post intracranial tumor resection seems to be associated with increased operative duration.However,it could effectively reduce the incidence of postoperative CSF leakage without increasing the incidences of related complications.