垂体腺瘤术后延迟性脑脊液鼻漏影像学特点及鼻内镜修补术

目的总结垂体腺瘤术后延迟性脑脊液鼻漏影像学特点和鼻内镜修补术经验。方法共23例垂体腺瘤术后延迟性脑脊液鼻漏患者,脑脊液鼻漏均发生于垂体腺瘤术后1～5年,常规行腰椎穿刺脑脊液检查、头部MRI检查、脑池造影CT动态扫描和鼻内镜检查,明确漏口位置后行鼻内镜下脑脊液鼻漏修补术,漏口较大患者使用肌肉填塞,再使用异种脱细胞真皮基质修补,漏口较小患者直接使用异种脱细胞真皮基质修补,蝶窦内填塞明胶海绵和碘仿纱条。结果本组患者共住院3～5周,其中20例行1次鼻内镜修补术、2例行2次鼻内镜修补术、1例行3次鼻内镜修补术;术后随访3个月至5年,所有患者均未再出现脑脊液鼻漏。结论垂体腺瘤术后延迟性脑脊液鼻漏的主要原因是术后残留肿瘤组织生长和术后辅助放射治疗,由于肿瘤大部分位于鞍内,适用于鼻内镜下垂体腺瘤切除术和脑脊液鼻漏修补术,手术安全且成功率较高。

The imaging characteristics and nasal endoscopic repair surgery for delayed postoperative cerebrospinal fluid rhinorrhea in patients with pituitary tumor

Objective To investigate the imaging characteristics and nasal endoscopic repair surgery for delayed postoperative cerebrospinal fluid (CSF) rhinorrhea in patients with pituitary tumor.Methods From June 2009 to November 2014 there were 23 cases with delayed CSF rhinorrhea in our hospital,which occurred one year to 5 years after the operation for pituitary tumor.Pituitary hormone assay,head MRI,cisternal CT and nasal endoscopic examination were performed in all patients.After definite diagnosis the patients underwent nasal endoscopic repair surgery of CSF rhinorrhea.During the operation,large leakage orifices were packed with muscle,and then patched with xenogenic acellular dermal matrix,while the small ones were directly patched with xenogenic acellular dermal matrix after tumor resection,and the sphenoid sinus was packed with gelatin sponge and iodoform gauze.Results Patients were hospitalized for 3 to 5 weeks.Among them,20 patients were successfully recured after one nasal endoscopic repair surgery,2 underwent the second surgery,and one underwent the third surgery.Patients were followed up for 3 months to 5 years with no CSF rhinorrhea reoccurred.Conclusions Delayed postoperative CSF rhinorrhea in patients with pituitary tumor were likely due to residual tumor growth and postoperative radiotherapy.Pituitary tumor often occur in sella,thus nasal endoscopic resection and repair surgery is feasible in treatment.The surgery is safe and the success rate is high.