水密缝合修补在神经内镜扩大经鼻蝶入路鞍结节脑膜瘤切除后颅底重建中的应用价值分析  

Watertight suture technique in skull base reconstruction after expanded endoscopic endonasal excision of tuberculum sellae meningioma

作　　者：刁玉领[1] 常海刚[1] 徐大伟[1] 李富光 周文科[1] Diao Yuling;Chang Haigang;Xu Dawei;Li Fuguang;Zhou Wenke(Department of Neurosurgery,First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院神经外科,新乡453100

出　　处：《中华神经医学杂志》2023年第2期165-169,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨应用水密缝合修补技术进行神经内镜扩大经鼻蝶入路鞍结节脑膜瘤切除后颅底重建的可行性及其临床疗效。方法新乡医学院第一附属医院神经外科自2018年1月至2022年5月采用神经内镜扩大经鼻蝶入路手术治疗14例鞍结节脑膜瘤患者,颅底重建时采用阔筋膜对鞍底硬脑膜缺损进行水密缝合修补,修补后鞍底再覆盖一层较大的阔筋膜加固,均未应用鼻中隔黏膜瓣。回顾性分析患者的临床资料和疗效。结果14例患者的肿瘤均获得影像学全切除;术中经Valsalva通气试验证实,要达到水密缝合状态,至少需要缝合12针。14例患者中,13例获得了水密缝合状态,均未发生脑脊液漏;1例因术中鞍底硬脑膜受肿瘤侵犯而切除较多,未达到水密缝合状态,术后出现短暂性脑脊液漏,卧床2周后脑脊液漏消失。11例视力视野损害患者中,9例明显改善,2例无改善。14例患者术后随访(26.8±8.4)个月(范围5~53个月),均未发现肿瘤复发,均无脑脊液漏发生;2例视力视野无改善患者截至末次随访时视力视野仍无明显改善。结论采用阔筋膜对鞍底硬脑膜缺损行水密缝合修补的方式进行神经内镜扩大经鼻蝶入路鞍结节脑膜瘤切除后颅底重建可行且效果较好。Objective To explore the feasibility and clinical efficacy of watertight suture technique in skull base reconstruction after expanded endoscopic endonasal excision of tuberculum sellae meningioma.Methods Fourteen patients with tuberculum sellae meningioma accepted expanded endoscopic endonasal excision of tuberculum sellae meningioma in Department of Neurosurgery,First Affiliated Hospital of Xinxiang Medical University from January 2018 to May 2022 were chosen.During reconstruction of skull base,femoral fascia was used to repair the dural defect of sellar base with watertight suture,and then the sellar base was covered with a larger layer of femoral fascia for reinforcement;no nasal septum mucosal flap was used.The clinical data and treatment efficacy of these patients were retrospectively analyzed.Results Total resection showed by imaging was achieved in all 14 patients.During the surgery,Valsalva ventilation test confirmed that at least 12 stitches were needed to achieve watertight suture status;watertight suture status was achieved in 13 of the 14 patients,without cerebrospinal fluid(CSF)leakage;watertight suture status was not achieved in one patient due to tumor invasion of the sella floor dura and having an extensive excision,and CSF leakage appeared transiently after surgery but disappeared 2 weeks after surgery(bed rest).Among the 11 patients with visual damage and optic field defect,9 patients improved obviously and 2 patients did not improve.Follow-up was performed for 5-53 months,with an average of(26.8±8.4)months;no tumor recurrence or CSF leakage were found in these patients;up to the last follow-up,the 2 patients with visual damage and optic field defect did not improve.Conclusion Skull base reconstruction using watertight suture technique after expanded endoscopic endonasal excision of tuberculum sellae meningioma is reliable.

关 键 词：鞍结节脑膜瘤 神经内镜扩大经鼻蝶入路 水密缝合修补 颅底重建 鼻中隔黏膜瓣 

分 类 号：R739.45[医药卫生—肿瘤]