확장성 내시경 수술 후 발생한 2-3등급 뇌척수액 유출을 막기 위한 두개저 재건술 시 요추 배액법과 하이드록시아파타이트 방법의 비교 분석

Comparison of the lumbar drain and the hydroxyapatite methods for skull base reconstruction for grade 2 or 3 cerebrospinal fluid leakage after extended endoscopic surgery

Background : Although the skull base reconstruction to prevent cerebrospinal fluid (CSF) leakage is extremely critical for the extended endoscopic approach (EEA), The purpose of this report is to evaluate the clinical outcome of skull base reconstruction methods after EEA. Methods : The consecutive 62 cases with grade 2 or 3 CSF leakage after EEA at Asan Medical Center were enrolled in this study. Preoperative diagnosis of the patients included 19 pituitary adenomas (30.7%), 14 meningiomas (22.6%), 9 craniopharyngiomas (14.5%), 9 sinonasal malignancies (14.5%), 6 Rathke’s cleft cysts (9.7%), and 4 chordomas (6.5%). The vascularized nasoseptal flap was used in all cases. We performed the CSF lumbar drainage after surgery (L-method) in 30 patients (48.4%) and applied the injectable hydroxyapatite cement for skull base reconstruction without L-drainage (H-method) in 28 patients (45.2%). The clinical outcomes and risk between the L- and H-method were assessed and compared each other. Results : The overall reconstruction-related complication and CSF leakage rates were 12.9% (8/62) and 8.1% (5/62). The complication and CSF leakage rates of the L-method (10.0% and 6.7%, respectively) and the H-method (17.9.% and 10.7%, respectively) were not significantly different (P = 0.386 and 0.583, respectively). While all infections occurred only in the H-method (P = 0.066), the postoperative hospital stay was significantly shorter in the H-method (7.9 ± 2.9 days) than that of the L-method (10.8 ± 6.2 days) (P = 0.035). Conclusions : The skull base reconstruction method using the hydroxyapatite effectively prevented the CSF leakage and provided comfort and shorter hospitalization to patients without postoperative lumbar drainage. When using the hydroxyapatite, however, the postoperative infection should be considered.