Watertight suture technique in skull base reconstruction after expanded endoscopic endonasal excision of tuberculum sellae meningioma
10.3760/cma.j.cn115354-20221107-00803
- VernacularTitle: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
- Author:
Yuling DIAO
1
;
Haigang CHANG
;
Dawei XU
;
Fuguang LI
;
Wenke ZHOU
Author Information
1. 新乡医学院第一附属医院神经外科，新乡 453100
- Keywords:
Tuberculum sellae meningioma;
Expanded endoscopic endonasal approach;
Watertight suture;
Skull base reconstruction;
Nasoseptal flap
- From:
Chinese Journal of Neuromedicine
2023;22(2):165-169
- CountryChina
- Language:Chinese
-
Abstract:
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.
