神经内镜经鼻硬膜缝合结合多层次颅底重建治疗高流量脑脊液漏的疗效

The effect of neuroendoscopic transnasal dural suturing combined with multi-layer skull base reconstruction in the treatment of high-flow cerebrospinal fluid leakage

目的观察神经内镜经鼻硬膜缝合结合多层次颅底重建治疗颅内肿瘤切除术中高流量脑脊液漏的效果。方法纳入2015年6月至2021年7月盐城市第一人民医院神经外科(26例)和南京医科大学附属脑科医院神经外科(34例)在神经内镜经鼻颅内肿瘤切除术中发生高流量脑脊液漏的患者,其中32例采用硬膜缝合结合多层次颅底重建技术修补颅底(硬膜缝合组),28例采用未缝合硬膜的多层次颅底重建技术修补颅底(对照组)。回顾性分析两组术后颅内感染、脑脊液漏、二次手术的发生率,行腰大池引流术的比率,以及术后下床活动时间和住院时间的差异。结果硬膜缝合组术后脑脊液漏、二次手术的发生率分别为6.3%(2/32)、3.1%(1/32),行腰大池引流术的比率为31.5%(10/32),术后中位下床活动时间和住院时间分别为8 d、11 d;对照组术后脑脊液漏、二次手术的发生率分别为28.6%(8/28)、21.4%(6/28),行腰大池引流术的比率为89.2%(25/28),术后中位下床活动时间和住院时间分别12 d、16 d,两组比较上述指标差异均有统计学意义(均P<0.05)。而颅内感染的发生率差异无统计学意义(P=0.281)。结论神经内镜经鼻入路硬膜缝合结合多层次颅底重建治疗颅内肿瘤切除术中高流量脑脊液漏的效果优于未缝合硬膜,并可缩短患者的下床活动时间和住院时间。

Objective To observe the effect of neuroendoscopic transnasal dural suturing combined with multi-layer skull base reconstruction in the treatment of high-flow cerebrospinal fluid(CSF)leakage during brain tumor resection.Methods This study enrolled patients with high-flow CSF leakage during neuroendoscopic transnasal intracranial tumor resection from June 2015 to July 2021 at the Department of Neurosurgery of the First People′s Hospital of Yancheng(26 cases)and Affiliated Nanjing Brain Hospital,Nanjing Medical University(34 cases).Among them,dural suturing combined with multi-layer skull base reconstruction was performed in 32 cases(dural suturing group),multi-layer skull base reconstruction without dural suturing was performed in 28 cases(control group).We retrospectively analyzed the incidences of postoperative intracranial infection,CSF leakage,a second operation,the rate of lumbar cistern drainage,and the differences in the postoperative ambulation time and the length of hospital stay in the two groups.Results In the dural suturing group,the incidences of CSF leakage and a second operation were 6.3%(2/32)and 3.1%(1/32)respectively.The rate of lumbar cistern drainage was 31.5%(10/32),and the median postoperative ambulation time and hospital stay were 8 d and 11 d respectively.In the control group,the incidences of CSF leakage and a second operation were 28.6%(8/28)and 21.4%(6/28)respectively,and the rate of lumbar cistern drainage was 89.2%(25/28).The median postoperative ambulation time and hospital stay were 12 d and 16 d respectively.There were statistically significant differences in the above indexes between the two groups(all P<0.05).There was no significant difference in the incidence of intracranial infection between the two groups(P=0.281).Conclusion The effect of dural suturing combined with multi-layer skull base reconstruction for the treatment of high-flow CSF leakage during intracranial tumor resection is better than that of multi-layer reconstruction without dural suturing,which could also shorten the time of ambulation and hospital stay.