RÉSUMÉ
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.
RÉSUMÉ
Objective:To explore the feasibility and clinical efficacy of resection of jugular foramen schwannomas via anterolateral approach. Methods:A retrospective analysis was conducted on clinical data of 15 patients with jugular foramen schwannomas admitted to Department of Neurosurgery, First Affiliated Hospital of Xinxiang Medical College from January 2018 to July 2022. Three patients had Samii type B, 7 had type C and 5 had type D. Resection of the schwannomas was performed via anterolateral approach. After surgery, regular follow-up was performed through outpatient review, telephone, or WeChat to evaluate tumor progression and neurological functions. Results:Adequate surgical exposure was obtained in all 15 patients. Total resection was obtained in 14 patients and subtotal resection in 1 patient. Posterior cranial nerve palsy was worsened in 1 patient and new-onset facial paralysis (House-Brackmann grading Ⅲ) was noted in 1 patient, without cerebrospinal fluid leakage, subcutaneous effusion or death. Choking and cough during drinking water, and dysphagia disappeared or relieved 3 months after surgery in patients with aggravated posterior cranial nerve palsy, but no significant recovery from hoarseness was noted 6 months after surgery. A patient with new-onset facial paralysis improved to House-Brackmann grading I 3 months after surgery. Up to the last follow-up, no tumor recurrence was observed in 15 patients.Conclusion:Resection via anterolateral approach is effective in jugular foramen schwannomas for its adequate surgical exposure, high total resection rate, and low postoperative complications.