ABSTRACT
Objective To explore the therapeutic effect of pedicled nasal septum mucosal flap on high-flow cerebrospinal fluid leakage in transsphenoidal approach. Methods The clinical data of 31 patients with high-flow cerebrospinal fluid leakage during neuroendoscope transsphenoidal approach from January 2012 to April 2018 were analyzed retrospectively. Among them, skull base of 18 patients was reconstructed with pedicled nasal septum mucosal flap technique (observation group), and skull base of 13 patients was reconstructed with the'sandwich'method (control group). The postoperative cerebrospinal fluid leakage and complications were compared between 2 groups. Results Postoperative cerebrospinal fluid leakage occurred in 6 cases in control group, and 1 case in observation group, and there was statistical difference between 2 groups (P<0.05). Postoperative olfactory loss occurred in 2 cases in control group, and 3 cases in observation group, and there was no statistical difference between 2 groups (P>0.05). Conclusions Multilayer skull base reconstruction with pedicled nasal septum mucosal flap can significantly reduce the incidence of cerebrospinal fluid leakage after transsphenoidal tumor resection, and is a safe and reliable method to treat the high flow cerebrospinal fluid leakage in operation.
ABSTRACT
Objective To evaluate the monitoring effect of microvascular Doppler blood flow detector in intracranial aneurysm surgery. Methods One hundred and twenty patients with intracranial aneurysms from July 2015 to July 2017 who received craniotomy and used microvascular Doppler ultrasound 1 mm microprobe to detect the hemodynamics of the parent artery and related perforating artery change were retrospectively analyzed . According to the blood flow signal, aneurysm clip was not adjusted in 55 cases; when the tumor artery or perforator artery blood flow signal decreased or disappeared after treatment, aneurysm clip clamping position was changed in 65 cases, so that the blood flow of tumor artery or perforator artery returned to normal. The blood flow velocity and pulsation index (PI) of the artery was measured before and after adjustment of the aneurysm clip. The patients underwent CT angiography (CTA) or DSA examination 1 week after surgery. Angiography was performed to evaluate the postoperative results in one month, three months, and six months' follow-up. The data obtained were statistically analyzed. Results Vascular obstruction or neck residual rate of 120 cases was lower than 5％vascular obstruction or residual neck residual rate in large cases. Conclusions The microvascular Doppler blood flow detector is safe, reliable and easy to operate. This technique is useful for finding the clips in the craniotomy of the intracranial aneurysm or the incomplete clamping of the tumor-bearing artery, so as to adjust the position of the aneurysm clip in time and improve the curative effect.
ABSTRACT
Objective@#To explore the therapeutic effect of modified pedicled nasal septum mucosa flap on cerebrospinal fluid leakage in transsphenoidal pituitary surgery.@*Methods@#The clinical data of 28 patients treated with modified pedicled nasal septal mucosa flap during endoscopic transsphenoidal resection of pituitary adenoma in Dalian Central Hospital from August 2017 to December 2018 were analyzed retrospectively. Seven cases of high-flow cerebrospinal fluid leakage occurred during the operation. Skull base reconstruction was performed with modified pedicled nasal septum mucosal flap. Modified pedicled nasal septum mucosal flap was repositioned in 21 cases.@*Results@#Seven cases of modified pedicled nasal septum mucosal flap for skull base reconstruction had no postoperative cerebrospinal fluid leakage and 1 case had hypoolusia. Postoperative cerebrospinal fluid leakage occurred in One of the 21 patients with mucosal flap replacement, and stopped after 8 d of continuous lumbar drainage. One case had hypoolusia.@*Conclusions@#Modified pedicled nasal septum mucosal flap is a safe and reliable technique. It can not only achieve the effect of pedicled nasal septum mucosal flap in skull base reconstruction, but also avoid nasal complications caused by excessive application of mucosal flap.
ABSTRACT
explore the therapeutic effect of modified pedicled nasal septum mucosa flap on cerebrospinal fluid leakage in transsphenoidal pituitary surgery. Methods The clinical data of 28 patients treated with modified pedicled nasal septal mucosa flap during endoscopic transsphenoidal resection of pituitary adenoma in Dalian Central Hospital from August 2017 to December 2018 were analyzed retrospectively. Seven cases of high-flow cerebrospinal fluid leakage occurred during the operation. Skull base reconstruction was performed with modified pedicled nasal septum mucosal flap. Modified pedicled nasal septum mucosal flap was repositioned in 21 cases. Results Seven cases of modified pedicled nasal septum mucosal flap for skull base reconstruction had no postoperative cerebrospinal fluid leakage and 1 case had hypoolusia. Postoperative cerebrospinal fluid leakage occurred in One of the 21 patients with mucosal flap replacement, and stopped after 8 d of continuous lumbar drainage. One case had hypoolusia. Conclusions Modified pedicled nasal septum mucosal flap is a safe and reliable technique. It can not only achieve the effect of pedicled nasal septum mucosal flap in skull base reconstruction, but also avoid nasal complications caused by excessive application of mucosal flap.