神经内镜下右侧单鼻孔经鼻蝶入路垂体瘤切除术中出现脑脊液漏的处理体会

Treatment of cerebrospinal fluid leakage during pituitary adenoma resection via right single-nostril transsphenoidal approach under neuroendoscope

目的总结神经内镜下右侧单鼻孔经鼻蝶入路垂体瘤切除术中出现脑脊液漏的处理经验,有利于后期更好开展该项技术。方法34例垂体瘤患者,均行神经内镜下右侧单鼻孔经鼻蝶入路垂体瘤切除术,术中根据脑脊液漏的程度采用脂肪填塞、腰大池引流、鞍底修补等方法。分析术中及术后脑脊液漏发生情况以及处理方法。结果34例患者术中出现脑脊液漏9例,发生率为26.5%;其中2例为小流量脑脊液漏,7例为大流量脑脊液漏。2例小流量脑脊液漏采用取大腿内侧或腹壁脂肪填塞瘤腔,采用明胶海绵、人工硬膜、生物蛋白胶修补鞍底。7例大流量脑脊液漏在上述处理基础上行腰大池置管外引流术。经处理后术中无再脑脊液漏,未发生颅内感染,无死亡病例。结论神经内镜下右侧单鼻孔经鼻蝶入路垂体瘤切除术中,针对不同程度脑脊液漏采用相应措施处理脑脊液漏,能很大程度减少术后脑脊液漏。

Objective To summarize the experience in the treatment of cerebrospinal fluid leakage during pituitary adenoma resection via right single-nostril transsphenoidal approach under neuroendoscope.Methods 34 patients with pituitary adenoma all underwent cerebrospinal fluid leakage during pituitary adenoma resection via right single-nostril transsphenoidal approach under neuroendoscope.During the operation,fat packing,lumbar drainage,and sellar repair were used according to the degree of cerebrospinal fluid leakage.The occurrence of intraoperative and postoperative cerebrospinal fluid leakage and treatment methods were analyzed.Results In 34 patients,9 cases of cerebrospinal fluid leakage occurred during the operation,the incidence rate was 26.5%,of which 2 cases had small-flow cerebrospinal fluid leakage and 7 cases had large-flow cerebrospinal fluid leakage.In 2 cases of low-flow cerebrospinal fluid leakage,the inner thigh or abdominal wall fat was used to fill the tumor cavity,and gelatin sponge,artificial dura mater,and biological protein glue were used to repair the saddle.7 cases of large-flow cerebrospinal fluid leakage were treated with external drainage of lumbar cistern on the basis of the above treatment.After treatment,there was no leakage of cerebrospinal fluid,no intracranial infection,and no deaths.Conclusion During pituitary adenoma resection via right single-nostril transsphenoidal approach under neuroendoscope,the corresponding measures to deal with cerebrospinal fluid leakage can greatly reduce the postoperative cerebrospinal fluid leakage.