神经内镜下经鼻垂体瘤切除术中脑脊液漏危险因素分析及颅底修补方式探讨

Risk factors and repair strategy of intraoperative cerebrospinal fluid leakage by neuroendoscopic transnasal resection of pituitary tumor

目的探讨神经内镜下经鼻垂体瘤切除术中发生脑脊液漏的危险因素及颅底修补策略。方法以2018年1月—2019年12月在徐州医科大学附属医院神经外科行神经内镜下经鼻垂体瘤切除术的186例患者为研究对象,分析其临床资料,比较垂体瘤的大小、类型、质地、侵袭性、切除程度及二次手术等与术中脑脊液漏的相关性,通过多因素分析,探讨术中脑脊液漏的危险因素。根据术中脑脊液漏分级情况,采取相应的颅底修补策略。结果术中34例(18.3%)患者出现脑脊液漏,肿瘤大小、质地及二次手术是术中脑脊液漏的独立危险因素,而垂体瘤的类型、Knosp分级及手术切除程度与术中脑脊液漏的发生无关。34例术中脑脊液漏患者中,Kelly分级1级18例,2级10例,3级6例,术后脑脊液漏6例,经保守治疗治愈5例,1例患者再次行颅底重建得以修复,术后随访3个月~1年,未见脑脊液漏复发。结论神经内镜下经鼻垂体瘤切除术中脑脊液漏的发生与肿瘤大小、质地及二次手术相关。一旦术中出现脑脊液漏,分级颅底修补安全、有效。

Objective To explore the risk factors of intraoperative cerebrospinal fluid leakage and repair strategy of skull base defects during neuroendoscopic transnasal resection of pituitary tumor.Methods A total of 186 patients with pituitary adenoma who underwent neuroendoscopic transnasal resection of pituitary tumor in the Affiliated Hospital of Xuzhou Medical University form January 2018 to December 2019 were enrolled.Their clinical data were analyzed,and the relationships between tumor size,type,texture,invasion,degree of resection and secondary operation with intraoperative cerebrospinal fluid leakage were compared.The risk factors of intraoperative cerebrospinal fluid leakage were discussed through multivariate analysis.According to the classification of cerebrospinal fluid leakage during operation,the corresponding repair strategy of skull base was adopted.Results There were 34(18.3%)patients with intraoperative cerebrospinal fluid leakage.Tumor size,texture and secondary operation were the independent risk factors for intraoperative cerebrospinal fluid leakage.However,the type of pituitary tumor,Knosp grade,and surgical resection degree were not clearly related with the occurrence of intraoperative cerebrospinal fluid leakage.Among the 34 patients with intraoperative cerebrospinal fluid leakage,18 cases were grade 1,10 cases were grade 2,and 6 cases were grade 3.There were 6 cases of postoperative cerebrospinal fluid leakage,in which 5 cases were cured by conservative treatment,and only 1 case was repaired through skull base reconstruction.No cerebrospinal fluid leakage was observed during postoperative follow-up of 3 months to 1 year.Conclusions Cerebrospinal fluid leakage during neuroendoscopic transnasal resection of pituitary tumor is related to tumor size,texture and secondary operation.Once cerebrospinal fluid leakage occurs during the operation,graded repair of skull base repair is safe and effective.