Application of bone-mucosa embedding reconstruction with naso-sphenoidal in-situ autologous material on medium-flow cerebral spinal fluid leak during endoscopic endonasal surgery of pituitary adenoma / 西安交通大学学报(医学版)

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.