内窥镜下经蝶入路切除垂体瘤并发脑脊液漏术中颅底重建  

Management of CSF leakage in transsphenoidal surgery for pituitary adenoma

作　　者：吕著海[1] 杨伦先[1] 张玉海[1] 胡新华[1] 

机构地区：[1]南京医科大学附属脑科医院神经外科,南京210029

出　　处：《立体定向和功能性神经外科杂志》2014年第4期204-207,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨内窥镜经单鼻孔蝶窦入路切除垂体瘤术中脑脊液漏的处理及颅底重建要点。方法术中辨明脑脊液漏的原因,观察蛛网膜破口确切位置,或脑脊液流出方向,针对性进行脑脊液漏的修补。过程分为1修补鞍隔小漏口用明胶海绵塑型填塞;大的漏口用自身脂肪塑型填塞。骨性裂隙用骨蜡密封。长针头均匀注入纤维蛋白胶或EC胶封闭。2重建鞍底略大于鞍底术野窗的人工硬脑膜,置入鞍内,再予薄层速即纱,使之与鞍内硬膜接触均匀,长针头均匀注入纤维蛋白胶或EC胶。再用有一定支持强度可吸收人工硬脑膜,根据鞍底骨窗大小和形状修剪,略大于鞍底,置于鞍外。医用胶充填各层及间隙,使鞍底内外连为一个整体。3加固鞍底对于鞍隔破口很大,进一步于大腿外侧取适度大小肌肉条,捶打成肌浆,平铺于鞍底,用明胶海绵柔性挤压,使之适形地消除鞍底与肌浆之间隙,纤维蛋白胶或EC胶等医用胶固定。结果本组术中发生脑脊液漏12例。其中2例破口位于前方鞍隔,10例位于上方鞍隔。术中均满意修补。术后随访2-12个月,平均7个月,未发生脑脊液鼻漏。结论经单鼻孔蝶窦入路切除垂体瘤并发脑脊液漏,术中及时行个性化的多重夹层式修补,有效可靠。Objective To explore the management of CSF leakage in transsphenoidal surgery for pituitary adenoma.Methods Judge the reseason of CSF leakage,observe the site and direction of CSF leakage.Mutilayer patching blockage and individualized management were performed during the operation.1 Repair sellae diaphrama：small ventage packing with gelatin sponge,big ventage packing with fat.Osseous gap packing with bone wax.Blocking with fibrain glue or EC glue turn to long needle.2 Reconstruction of basilar pituitary fossa：to cover inside of basilar pituitary fossa with the more bigger dura,blocking with fibrain glue or EC glue.Then,to cover lateral of basilar pituitary fossa with the more bigger dura,blocking with fibrain glue or EC glue,to form a global of inside and lateral of basilar pituitary fossa.3 Strengthening basilar pituitary fossa：for big ventage to take some muscle to pound into muscle plasma and sofetly compression with gelatin sponge in order to dismiss interspace of muscle plasma and basilar pituitary fossa.Blocking with fibrain glue or EC glue.Results 12 cases of CSF leakage were repaired sucessfully.2 cases ventage lie in ahead of sellae diaphrama,10 caseses ventage lie in anodic of sellae diaphrama.All cases,follow up 7-12 months average 7 months all cases have no leakage post operation.Conclusion Mutilayer patching blockage is an effective way in management of CSF leakage during in transsphenoidal surgery for pituitary adenoma.

关 键 词：经蝶 垂体瘤 脑脊液漏 多重修补 

分 类 号：R736.4[医药卫生—肿瘤]