内镜下鞍区占位术中脑脊液漏的分级及处理

The classification and treatment of cerebrospinal fluid leakage during resection of occupying lesions in saddle area trans-neuroendoscopy

目的介绍神经内镜经鼻-蝶窦鞍区占位切除术中脑脊液漏不同分级及处理方法。方法回顾性分析2015-06—2020-06盐城市第一人民医院神经外科完成的165例内镜经鼻-蝶窦入路鞍区占位手术的患者临床资料,包括肿瘤的病理类型、鞍膈破损的大小、术中修复方法、术后并发症。结果根据鞍底硬膜缺损大小进行脑脊液漏分级,本组患者0级129例,Ⅰ级14例,Ⅱ级12例,Ⅲ级10例。术后脑脊液漏16例,分布在各个级别的患者中,13例经腰穿置管后漏液控制,3例再次手术修补。术后颅内感染7例,其中死亡2例,其余均经抗炎治疗后好转。所有出院患者经3个月~5 a随访,无脑脊液漏发生。结论根据术中脑脊液漏的不同分级,采用不同的重建方式进行修补,结合鞍底硬膜缝合可有效避免术后及远期脑脊液漏的发生。

Objective To introduce the classification and treatment of intraoperative cerebrospinal fluid leakage during neuroendoscopic transnasal-sphenoid sinus resection.Methods The clinical data of 165 patients who underwent endoscopic transsphenoidal approach in sellar region from June 2015 to June 2020 in the neurosurgery department of Yancheng First People ’ s hospital were analyzed retrospectively,including the pathological type of tumor,the size of the rupture of the sellar septum,the corresponding repair method of the sellar base during the operation,and the postoperative complications.Results Classification of cerebrospinal fluid leakage according to the size of the dural defect,there were 129 cases of grade 0,14 cases of grade Ⅰ,12 cases of grade Ⅱ and 10 cases of grade Ⅲ.There were 16 cases of postoperative cerebrospinal fluid leakage,which were distributed in all grades of patients.The leakage was controlled by lumbar puncture tube in 13 cases,and 3 cases were given surgical repair once again.There were 7 cases of intracranial infection after operation,among which 2 cases died.The rest were improved after anti-inflammatory treatment.No cerebrospinal fluid leakage occurred in discharged patients during 3 months to 5 years follow-up visit.Conclusion According to the different grades of cerebrospinal fluid leakage,different reconstruction methods and combined with sellar dural suture,which can effectively avoid postoperative and long-term cerebrospinal fluid leakage.