[1]陆冬,赵赛赛,苗发安,等.神经内镜下经鼻垂体瘤切除术中脑脊液漏危险因素分析及颅底修补方式探讨[J].徐州医科大学学报,2022,42(05):313-317.[doi:10.3969/j.issn.2096-3882.2022.05.001]
 Risk Factors and treatment of Intraoperative Cerebrospinal Fluid Leaks by Endoscopic transnasal resection of Pituitary Adenoma[J].Journal of Xuzhou Medical University,2022,42(05):313-317.[doi:10.3969/j.issn.2096-3882.2022.05.001]
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神经内镜下经鼻垂体瘤切除术中脑脊液漏危险因素分析及颅底修补方式探讨()
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《徐州医科大学学报》[ISSN:2096-3882/CN:32-1875/R]

卷:
42
期数:
2022年05期
页码:
313-317
栏目:
出版日期:
2022-05-25

文章信息/Info

Title:
Risk Factors and treatment of Intraoperative Cerebrospinal Fluid Leaks by Endoscopic transnasal resection of Pituitary Adenoma
作者:
陆冬赵赛赛苗发安张玉东董成祥聂耳谢满意
徐州医科大学附属医院神经外科,江苏徐州221002
关键词:
神经内镜垂体肿瘤脑脊液漏颅底修补
分类号:
R739.41
DOI:
10.3969/j.issn.2096-3882.2022.05.001
文献标志码:
A
摘要:
目的探讨神经内镜下经鼻垂体瘤切除术中发生脑脊液漏的危险因素及颅底修补策略。 方法以2018年1月—2019年12月在徐州医科大学附属医院神经外科行神经内镜下经鼻垂体瘤切除术的186例患者为研究对象,分析其临床资料,比较垂体瘤的大小、类型、质地、侵袭性、切除程度及二次手术等与术中脑脊液漏的相关性,通过多因素分析,探讨术中脑脊液漏的危险因素。根据术中脑脊液漏分级情况,采取相应的颅底修补策略。结果术中34例(18.3%)患者出现脑脊液漏,肿瘤大小、质地及二次手术是术中脑脊液漏的独立危险因素,而垂体瘤的类型、Knosp分级及手术切除程度与术中脑脊液漏的发生无关。34例术中脑脊液漏患者中,Kelly分级1级18例,2级10例,3级6例,术后脑脊液漏6例,经保守治疗治愈5例,1例患者再次行颅底重建得以修复,术后随访3个月~1年,未见脑脊液漏复发。结论神经内镜下经鼻垂体瘤切除术中脑脊液漏的发生与肿瘤大小、质地及二次手术相关。一旦术中出现脑脊液漏,分级颅底修补安全、有效。
Abstract:
ob<x>jective: To explore the risk factors of Intraoperative cerebrospinal fluid leakage and repair strategy of skull ba<x>se defects during neuroendoscopic transnasal pituitary tumor resection . Methods: We conducted a retrospective review of 186 patients with pituitary adenoma between January 2018 to December 2019, in ** ,who underwent endoscopic endonasal transsphenoidal surgeries .The clinical data were analyzed, and the correlation between the size, type, texture, invasivity, degree of resection,secondary operation of pituitary tumor and intraoperative cerebrospinal fluid leakage was compared. The risk factors of intraoperative cerebrospinal fluid leakage were discussed through multivariate statistical analysis.According to the classification of cerebrospinal fluid leakage during operation, the corresponding repair strategy of skull ba<x>se was adopted.Results:Of 186 patients ,there were 34(18.3%)patients with intraoperative cerebrospinal fluid leakage.The incidence of intraoperative cerebrospinal fluid leakage was correlated with tumor size, secondary operation, and tumor texture, and they were independent risk factors for intraoperative cerebrospinal fluid leakage. However, the type of pituitary tumor, Knosp grade, and surgical resection degree were not clearly correlated with the occurrence of intraoperative cerebrospinal fluid rhinorrhea, and the results were not statistically significant.Among the 34 patients with intraoperative cerebrospinal fluid leakage, 18 cases were grade 1, 10 cases were grade 2, and 6 cases were grade 3. There were 6 cases of postoperative cerebrospinal fluid rhinorrhea, 5 cases were cured by conservative treatment, and only 1 case was repaired by skull ba<x>se reconstruction . No recurrent cerebrospinal fluid rhinorrhea was observed during postoperative follow-up of 3 months to 1 year.Conclusion The occurrence of cerebrospinal fluid leakage during endoscopic transpituitary tumor resection is closely related to tumor size, secondary operation and tumor texture.Once cerebrospinal fluid leakage occurs during the operation,graded skull ba<x>se repair is safe and effective

相似文献/References:

[1]李祥、谷佳、孟庆明、苗发安、阴鲁釜、战文建.神经内镜在三叉神经痛显微血管减压术中的应用价值[J].徐州医科大学学报,2014,34(06):400.
 [J].Journal of Xuzhou Medical University,2014,34(05):400.

备注/Memo

备注/Memo:
基金项目:国家自然科学基金(81802490)*通信作者,E-mail:guoasg@ntu.edu.cn
更新日期/Last Update: 2022-06-07