Clinical Application Of Autogenous Bone In Sellar Floor And Sphenoid Sinus Reconstruction

Purpose:Cerebrospinal fluid（CSF）leakage is transsphenoidal a common but serious complication.In order to avoid the postoperative complications,reconstruction of the skull base.We usually use autologous materials such as fat,fascia or muscle,sometimes using nasal septum mucosa flap for repair of cerebrospinal fluid leakage.In this report,we propose a dissection technique of repair the new saddle bottom,using autogenous bone,sphenoid sinus,sellar repair,prevention of intraoperative and postoperative cerebrospinal fluid leakage in our department.The 127 clinical data by transsphenoidal resection of sellar region lesions in patients with sellar region lesions were retrospectively analyzed.The autogenous bone reconstruction in the sellar floor,and curative effect the method of the sphenoid sinus were summarized,in order to guide clinical work.Method:During the period of December 2012 to January 2013 in our department 62 cases underwent transsphenoidal surgery reconstructing sellar floor and sphenoid sinus（control group）and during January 2014 to February 2016 in our department 65 cases underwent transsphenoidal surgery without reconstructing sellar floor and sphenoid sinus（observation group）.The clinical data of 127 cases of the complete data,and follow-up data of surgery a retrospective analysis.Result:1.The comparison of and sphenoid sinus between the observation group and the control group is χ²=0.186,P =0.667.There was no statistically significant difference between the two groups（P>0.05）.It was comparable between the observation group and the control group.2.The observation group and the control group are of 127 patients.Postoperative confirmed 106 cases of pituitary adenomas（the immunohistochemical expression of PRL in 22 cases,GH 10 cases,ACTH 3 cases,TSH 2 cases,FSH 3 cases,LH 6 cases,no specific expression in 69 cases）,2 cases of pituitary tissue focal hyperplasia active,10 cases of Rathke cyst,5 cases of craniopharyngioma,2 cases of intrasellar meningioma,1 cases of neuroendocrine tumors,1 cases of non Hodgkin lymphoma.3.Two groups of patients with surgical excision of the tumor curative effect of 2=0.294,P =0.588.in this case χ²<χ²_0.05,1,therefore,the difference between the two groups was not statistically significant.Two groups used the same surgical method,different sellar reconstruction method,sphenoid sinus surgery for the cure rate,improvement rate has no obvious effect,the two groups of data are comparable.4.The observation group,the control group of the most common complications of cerebrospinal fluid leakage incidence using the chi square test was χ²=7.427 > χ²_0.05,1,P =0.006 < 0.05,two groups of cerebrospinal fluid leakage incidence was statistically significant.The data obtained from the analysis of the research group,the incidence rate of the observation group is P =2/65=3.07%,the control group the incidence rate of in control group is P =11/62=17.74%.It can be considered the incidence of cerebrospinal fluid leakage after operation in the observation group lower than in the control group the rate.Also,it can be sure sellar floor and sphenoid sinus reconstruction is good for preventing postoperative cerebrospinal fluid leakage.The observation group,the control group the incidence of intracranial infection rate by using Fisher exact test,P =0.025 < 0.05,two groups of intracranial infection rate was statistically significant.The data obtained from the analysis of the research group,the observation group the incidence rate of P =0 in the observation group,the control group,the incidence rate of P =5/62= in control group 8.06%,the incidence can be considered intracranial infection after operation in the observation group than in the control group the rate low incidence of postoperative intracranial infection prevention of retrograde effect.5.The observation group and the control group compared to χ²=4.577,P =0.032.in this case χ² > χ²_0.05,1,P < 0.05.Therefore,there was significant difference between two groups.The follow-up 1 months after operation in the two groups,different sellar reconstruction method,sphenoid sinus in patients with postoperative long-term clinical symptoms the improvement was statistically significant,patients in the observation group the sellar sphenoid sinus,reconstruction of postoperative symptoms to improve symptoms significantly better than the control group for sellar reconstruction without sphenoid sinus reconstruction group.In summary,the observation group of sellar floor and sphenoid sinus reconstruction can be significantly reduced through transsphenoidal approach and postoperative complications,can be widely used in clinical promotion and implementation.Conclusions:1 Autologous bone is the ideal material in reconstruction of the skull base in the transsphnoidal approach surgery.It has the advantage of easy to obtain and better tissue compatibility.2 The application of sphenoid sinus reconstruction in transsphnoidal approach surgery is a new technology.This technology not only can achieve anatomical reduction of sellar floor and sphenoid sinus,reduce the complications after teanssphnoidal approach surgery,but also have a better improvement of clinical symptoms than that of the control group during the postoperative follow-up.