Sellar Floor Reconstruction after Transsphenoidal Surgery: A Retrospective Analysis of 449 Cases of Pituitary Adenoma
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摘要:
目的 探讨经鼻蝶入路切除垂体腺瘤后鞍底重建的方法及效果。 方法 回顾分析2009年8月至2010年8月449例经鼻蝶入路切除垂体腺瘤患者资料。患者均接受单鼻孔入路经蝶窦手术，其中15例为内镜辅助下手术。52例术中出现鞍隔破损及脑脊液渗出或溢出，术中以止血棉纱、明胶海绵填塞瘤床，脑膜补片及生物胶封闭进行鞍底修补重建，术后脑脊液漏6例，迟发性脑脊液漏2例。术后脑脊液漏者，延迟撤除鼻腔填塞物并予降颅内压治疗。 结果 脑脊液漏发生率为术中11.58%（52/449），术后1.34%（6/449），迟发性0.45%（2/449）。按鞍内填塞并用脑膜补片及生物胶封闭的方法修补重建后仍有脑脊液漏者，予延长鼻腔填塞时间并辅以降颅压处理，绝大多数7d内自愈，最长3w后自愈。术后脑膜炎1例，对症治疗后治愈。 结论 经鼻蝶垂体瘤术后予以鞍内填塞，并应用脑膜补片加生物胶进行鞍底重建，可有效减少术后脑脊液漏发生率。 Abstract:Objective The technique and the effect of sellar floor reconstruction in 449 patients with pituitary adenoma who underwent transsphenoidal surgery were retrospectively analyzed. Methods A total of 449 patients received pituitary adenoma resection via the endonasal transsphenoidal approach (including 15 cases of endoscope-assisted surgery). Damage to the sellar diaphragm and leakage of the cerebrospinal fluid (CSF) occurred intraoperatively in 52 cases. The ventage of sellar diaphragm was packed with absorbable hemostatic cotton and gelatin sponge. Artificial dura mater and fibrin glue were then used to seal and to reconstruct the sellar floor. Post-operative CSF leakage in 6 cases and delayed CSF leakage occurred in 2 cases. To manage the CSF leakage, intranasal vaseline gauze was maintained in place; meanwhile continuous lumbar CSF drainage and mannitol were used to decrease the intracranial pressure. Results The incidence of CSF leakage was 12% (52 cases) during the surgery and 1.3% (6 cases) after surgery. The incidence of delayed CSF leakage was 0.45% (2 cases). Retention of the intranasal vaseline gauze and reduction of intracranial pressure were effective for treating postoperative CSF leakage. Most cases were cured in one week, whereas only one patient was cured after 3 weeks. One patient had meningitis and recovered after symptomatic treatment. Conclusion In transsphenoidal surgery for pituitary adenomas, accurate intrasellar packing and sellar floor reconstruction with artificial dura mater and fibrin glue effectively prevent postoperative CSF leakage. -
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