【摘要】 目的探讨在神经内镜扩大经鞍结节-蝶骨平台入路中应用原位骨瓣(In Situ Bone Flap)进行颅底骨性重建的优势和可行性。方法回顾性分析重庆医科大学附属第一医院神经外科2016年1月—2019年12月,采用神经内镜下扩大经鞍结节-蝶骨平台入路治疗的89例鞍区肿瘤患者的临床资料。所有患者均采用原位骨瓣进行颅底骨性重建;统计术后脑脊液漏及颅内感染的发生率,并结合文献分析使用原位骨瓣进行颅底骨性重建的应用。结果术后出现脑脊液漏的患者4例(4. 5%),经给予严格卧床、腰大池持续引流联合抗生素治疗后治愈,均未行手术修补;颅内感染患者3例(3. 4%)。术后随访患者2～48个月,随访期间无发生迟发性脑脊液漏及颅内感染者。术后复查颅底CT三维重建示,原位骨瓣经历了"骨质吸收-骨痂形成-鞍底重塑"的愈合过程。结论使用"原位骨瓣"技术对内镜下扩大经鞍结节-蝶骨平台入路进行颅底骨性重建,术后脑脊液漏的发生率较低,且具有一定的优势,值得在临床推广。更多还原

【Abstract】 Objective To investigate the advantage and feasibility of In Situ Bone Flap for skull base bone reconstruction via an extended endoscopic transplanum-transtuberculum-endonasal approach. Methods The clinical data of 89 patients with sellar tumors underwent surgery via extended endoscopic transplanum-transtuberculum-endonasal approach at Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2019 were analyzed retrospectively. All patients received bone reconstruction of skull base with In Situ Bone Flap,the incidence of postoperative cerebrospinal fluid leakage and intracranial infection was calculated,and the feasibility and advantages of rigid reconstruction of skull base by using In Situ Bone Flap were analyzed based on the literature. Results Postoperative cerebrospinal fluid leakage occurred in 4 cases( 4. 5%,4/89),none of them need operation to repair skull base again. They were cured by strictly bed rest and continuous lumbar cistern drainage combined with antibiotics. Postoperative intracranial infection was found in 3 patients( 3. 4%,3/89). There was no delayed cerebrospinal fluid leakage or intracranial infection during the follow-up period lasting for2-48 months. The In Situ Bone Flap underwent the healing process of "bone resorption-callus formation-sellar reconstruction"showed by the postoperative follow-up CT scan. Conclusion The adoption of In Situ Bone Flap technique for the bone reconstruction of the skull base can achieve a low incidence of postoperative cerebrospinal fluid leakage with certain advantages and deserves clinical promotion.更多还原