硬性重建在减少神经内镜鞍区占位术后脑脊液漏中的应用

目的探讨硬性重建能否减少内镜鞍区占位术后脑脊液漏的发生。方法回顾性分析2019年10月—2022年6月复旦大学附属肿瘤医院完成的128例内镜鞍区占位手术，患者颅底缺损采用硬性重建结合软性重建，或者单纯软性重建。分析术后两组脑脊液漏情况。结果90例采用硬性重建（70.3%），其中22例鼻中隔骨质修补（24.4%），68例（75.6%）采用聚醚醚酮（PEEK）修补。硬性重建组术后1周内脑脊液漏1例（1.0%），出院时自愈。软性重建组38例，术后1周内脑脊液漏6例（15.8%），5例出院时自愈。1例保守治疗无效，2个月后手术修补成功。结论硬性重建颅底可以减少内镜鞍区占位术后1周内的脑脊液漏发生率。

ObjectiveTo explore whether rigid reconstruction can reduce the occurrence of cerebrospinal fluid leakage after endoscopic sellar area occupying surgery. Methods128 cases of endoscopic sellar area occupying surgery completed by Fudan University Shanghai Cancer Center from October 2019 to June 2022 were analyzed retrospectively. Patients with skull base defects underwent rigid reconstruction combined with soft reconstruction, or simple soft reconstruction. The postoperative cerebrospinal fluid leakage in both groups were analyzed. ResultsThe rigid reconstruction was performed in 90 cases(70.3%), of which 22(24.4%) were repaired with nasal septum bone, and 68(75.6%) were repaired with polyetheretherketone(PEEK). One case(1.0%) of cerebrospinal fluid leakage occurred within one week after surgery in the rigid reconstruction group, and self healed upon discharge. In the soft reconstruction group of 38 cases, 6(15.8%) had cerebrospinal fluid leakage within 1 week after surgery, and 5 cases recovered spontaneously upon discharge. One case failed conservative treatment and was successfully repaired 2 months later. ConclusionThe rigid reconstruction of the skull base can reduce the incidence of cerebrospinal fluid leakage within one week after endoscopic sellar area occupying surgery.