游离肌肉联合纤维蛋白胶辅助封闭预防听神经瘤术后脑脊液漏效果的初步探讨  

A preliminary study of the effect of free muscle combined with biological protein glue on prevention of cerebrospinal fluid leak post acoustic neuroma surgery

作　　者：陈桂琳 马珩钞 郑玄 杨澳娇 张军[1] Chen Guilin;Ma Hengchao;Zheng Xuan;Yang Aojiao;Zhang Jun(Department of Neurosurgery,First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经外科医学部,北京100853

出　　处：《中华神经外科杂志》2025年第3期256-261,共6页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨采用游离肌肉联合纤维蛋白胶辅助封闭预防枕下经乙状窦后入路切除听神经瘤术后发生脑脊液漏的效果。方法回顾性分析2021年1月至2023年10月于解放军总医院第一医学中心神经外科医学部收治的听神经瘤患者的临床资料。所有患者均采用枕下经乙状窦后入路手术治疗,术中行内听道后壁磨除,并采用游离肌肉联合纤维蛋白胶封闭开放的内听道后壁。术后复查头颅增强MRI以评估肿瘤切除程度。术后定期行电话和门诊随访。采用House-Brackmann(H-B)面神经功能分级评估手术疗效。观察脑脊液漏及其他相关并发症的发生情况。结果共纳入184例听神经瘤患者,其中175例(95.11%)患者达到肿瘤全切除或近全切除,9例(4.89%)患者行次全切除。面神经功能保留率为97.28%(179/184)。9例(4.89%)患者出现术后脑脊液鼻漏并行腰大池置管持续引流,其中并发中枢神经系统感染者3例(1.63%)。所有患者均获得随访,中位随访时间为28.3(12.3~45.7)个月。末次随访时,H-B分级Ⅰ~Ⅱ级179例(97.28%),Ⅲ级5例(2.72%)。随访期间无一例脑脊液漏复发患者。结论初步研究表明,对于枕下经乙状窦后入路切除听神经瘤的患者,游离肌肉联合纤维蛋白胶辅助封堵可作为处理术中开放乳突气房的有效方式,有利于预防术后脑脊液漏,且并发症少。ObjectiveTo preliminarily investigate the effect of free muscle combined with biological protein glue on prevention of cerebrospinal fluid(CSF)leak after acoustic neuroma surgery via the retrosigmoid approach.MethodsThis study was conducted on patients with vestibular schwannomas treated at the Department of Neurosurgery,First Medical Center of PLA General Hospital from January 2021 to October 2023.All patients underwent surgery via the suboccipital retrosigmoid approach,with the posterior wall of the internal auditory canal removed and the open posterior wall sealed with free muscle combined with biological protein glue.Follow-up was conducted via telephone and outpatient visits.Surgical outcomes were evaluated using the House-Brackmann(H-B)facial nerve function grading system.The occurrence of CSF leak and other related complications was documented.ResultsA total of 184 patients with acoustic neuroma were included,among whom 175(95.11%)achieved gross total or near-total tumor resection,and 9(4.89%)underwent subtotal resection.The facial nerve function preservation rate was 97.28%(179/184).Nine patients(4.89%)developed postoperative CSF rhinorrhea and underwent continuous lumbar cistern drainage,among whom 3(1.63%)had central nervous system infection.All patients were followed up,with a median follow-up time period of 28.3 months(range:12.3 to 45.7 months).At the last follow-up,179 patients(97.28%)had H-B gradeⅠ-Ⅱ,and 5 patients(2.72%)had H-B gradeⅢ.No recurrence of CSF leak was documented during the follow-up period.ConclusionThis preliminary study suggests that free muscle combined with biological protein glue is an effective method for sealing the open mastoid air cells during surgery,which helps prevent postoperative CSF leak with minimal complications.

关 键 词：神经瘤 听 脑脊液漏 乙状窦后入路 游离肌肉 内听道 

分 类 号：R739.4[医药卫生—肿瘤]