ABSTRACT
【Objective】 To evaluate the efficacy and weight of sellar floor repair techniques such as different dura suture, bone reconstruction, and pedicled nasoseptal flap (PNSF) on the skull base reconstruction of medium and high flow cerebrospinal fluid leakage during endonasal endoscopic pituitary adenoma surgery. 【Methods】 We collected the data of Grade 2-3 cerebrospinal fluid leakage (Kelly grade) during endonasal endoscopic pituitary adenoma resection in our hospital from January 2015 to April 2021. Multiple reconstruction techniques such as dura suture, bone reconstruction and PNSF, and related factors such as age, sex, body mass index (BMI), diabetes, tumor size and diameter of diaphragmatic defect were recorded and introduced to multivariate regression to analyze the effects of the above factors on the duration of postoperative cerebrospinal fluid rhinorrhea and bed rest time, with a special focus on the weight priority of dura suture, bone reconstruction, and PNSF. 【Results】 A total of 281 patients were included, with the average age of (47±12.6) years, males accounting for 52.6%. There were 93 cases of PNSF, 268 cases of bone reconstruction, 109 cases of dura anchor suture, 50 cases of patch suture, and 122 cases without suture. The results of multivariate analysis indicated that the application of PNSF, bone reconstruction, and dura suture significantly reduced postoperative rhinorrhea time [reduced by 18.524, 35.876, and 16.983/19.791 (anchor suture/patch suture) hours, respectively; all PPNSF>bone reconstruction [Standard β=0.211/0.207 (anchor suture/patch suture)>0.200>0.165]. The weight of reducing bed time was bone reconstruction >dura suture > PNSF [Standard β=0.239>0.206/0.210 (anchor suture/patch suture) >0.164]. After stabilizing the learning curve in 25-30 cases, the average time for bone reconstruction was (3.9±0.4) minutes. After stabilizing learning curve in 30-40 cases, the dura suture technique took an average of (3.7±0.3) minutes per stitch, (3.7±1.0) stitches per case, and (13.6±2.7) minutes of total time consumption per case. 【Conclusion】 Dural anchoring and patching suture can both effectively shorten the duration of cerebrospinal fluid rhinorrhea and bed rest time. Bone reconstruction significantly improves the stability of reconstruction, especially in prompting patients’ early disengagement of bed rest. Moreover, the learning curves of the above two methods are economical and reasonable, and their weight is close to or even exceeds that of PNSF. Therefore, they can be an effective supplement or even substitute for PNSF.
ABSTRACT
【Objective】 To introduce the repair application in medium-flow cerebrospinal fluid leakage during transsphenoidal pituitary tumor resection by using autologous material from the surgical site in situ， combined with dural suture and bone-mucosa embedding technique， and evaluate its effect. 【Methods】 We conducted a retrospective case analysis of medium-flow cerebrospinal fluid leakage during endoscopic transsphenoidal approach pituitary tumor resection in our hospital from September 2016 to March 2020. All the collected cases were divided into two groups. In situ material harvest group： dural suture + in situ bone-mucosa embedding， avoiding additional trauma to the thigh and nasal cavity， referred to as in situ group. Traditional multi-layer reconstruction group： fat + fascia lata + pedicled nasoseptal flap （PNSF）， referred to as traditional group. The important indexes related to repair were compared and analyzed between the two groups. 【Results】 The in situ group and the traditional group consisted of 108 and 63 cases， respectively. The baseline data of the two groups were comparable. For the incidence of postoperative cerebrospinal fluid leakage ［（1/108， 0.9%） vs. （1/63， 1.6%）， P>0.05］ and intracranial infection rate ［（2/108， 1.9%） vs. （2/63， 3.2%）， P>0.05］， no statistical difference was shown between the groups. While compared with that in the traditional group， the mean postoperative bed stay time ［（3.7±1.6） vs. （4.4±1.5） days， P<0.001］ and the mean postoperative hospital stay ［（5.8±1.8） vs. （6.5±1.7） days， P<0.001］ of the in situ group were significantly shorter. The in situ group had significantly lower incidences of postoperative olfactory disturbance ［（0/108， 0%） vs. （3/63， 4.8%）， P<0.05］ and nasal discomfort ［（3/108， 2.8%） vs. （7/63， 11.1%）， P<0.05］. Follow-up imaging and endoscopic examination showed that the reconstructed structure of the in situ group was stable， and there was no delayed cerebrospinal fluid leakage. 【Conclusion】 This technique showed a reliable effect in repairing medium-flow leaks during transsphenoidal pituitary tumor resection by restoring the anatomical structure while avoiding the additional trauma. It is beneficial to shortening bed stay and hospitalization time and improving the subjective experience of patients， thus having a great value in clinical application.