Application Of Free Middle Turbinate Mucosal Flap In Repairing Low-flow Cerebrospinal Fluid Leakage

Background:Pituitary tumors are a common tumor in the saddle area and the third most common intracranial tumor,second only to gliomas and meningiomas.In recent years,with the progress of imaging examination and endocrine examination,the detection rate of pituitary tumors has increased year by year.Except for partial secretion of breast secretion adenoma,oral bromocriptine can be treated conservatively.Surgery is the treatment of choice.Nowadays,Transsphenoidal surgery(TSS)has become the treatment of choice for pituitary adenomas.In recent years,with the widespread use of neuroendoscopy-assisted surgery,the total tumor resection rate has become higher and higher.However,the incidence of postoperative cerebrospinal fluid(CSF)leakage has remained high.Once postoperative cerebrospinal fluid leakage occurs,it can cause intracranial infection,intracranial gas accumulation,and brain dysfunction.And the cost,so the closure,repair and reconstruction of the saddle bottom after tumor resection are particularly important.Saddle bottom reconstruction materials are generally divided into autologous materials and allogeneic materials.Autologous materials include: autologous fat,muscle,fascia,bone,mucosal flaps,etc.Autologous materials have the advantages of economy and easy access to materials.Its shortcomings are limited tissue source,difficulty in three-dimensional shaping,no absorption and necrosis of blood transplanted tissue,etc.,which may leave complications in the donor area and will lead to prolonged operation time.Allogeneic materials include: titanium mesh,steel plate,allogeneic acellular dermal matrix,gelatin sponge,artificial dura mater,etc.Synthetic materials can replace self-repair materials to avoid damage to themselves.The disadvantage is that foreign body rejection can occur Quality materials may also damage nearby nerves and blood vessels and other structures,and cost more.In 2006,Hadad and Bassagaisteguy proposed a pedicled Nasal Septum Flap(NSF).Pedicle NSF reduced the initial CSF leakage rate from overall> 20% to <5%,and the success rate after successful repair of high flow intraoperative CSF leakage was 94%.This is a reliable method,it is relatively easy to obtain a flap with a large surface area that can be rotated to cover a wide variety of skull base defects.Currently,NSF is widely used and is considered to be the main force for skull base reconstruction after transnasal butterfly surgery.However,the application of NSF to the nasal septal mucosa is more damaging,the production of mucosal flaps is more time-consuming,and the larger mucosal defects will cause nasal septal perforation and nasal discomfort.Can replace NSF.Purpose:To study the effect of free MTMF in repairing low-flow cerebrospinal fluid leakage during transnasal pituitary tumor resection.Method:Forty-one patients with pituitary tumors who underwent low-flow cerebrospinal fluid leakage under the endoscopic transnasal sphenoid approach in the People's Hospital of Henan Province between August 2017 and August 2019 were selected.The experimental group: 21 cases,using the free middle turbinate mucosal flap for saddle floor reconstruction,the control group: 20 cases,using the pedicled nasal septal mucosal flap for saddle floor reconstruction,comparing the length of operation,hospitalization time,and operation of the two groups of patients The incidence of posterior cerebrospinal fluid leakage,postoperative nasal scab,lack of sense of smell,and incidence of nasal septal perforation.Result:41 patients were 25 males and 10 females,with a maximum age of 45 years and a minimum age of 18 years.No cerebrospinal fluid leakage occurred in both groups after operation.The average operation time in the experimental group was 141 minutes,and the average operation time in the control group was 162.5 minutes(p <0.05),the difference was statistically significant;the average hospital stay of the experimental group was 6 days,and the average hospital stay of the control group was 6.15 days(P> 0.05),the difference was not statistically significant.Postoperative complications: nasal scab,experimental group: 0 cases,control group: 5 cases(P <0.05),the difference was statistically significant.Nasal septum perforation: experimental group: 0 cases,control group: 2 cases(P> 0.05),the difference was not statistically significant.Loss of smell,experimental group: 0 cases,control group: 1 case(P> 0.05),the difference was not statistically significant.Conclusion:1.The free middle turbinate mucosal flap is an effective repair material in low-flow cerebrospinal fluid leakage;2.In the repair of low-flow cerebrospinal fluid leakage,the free middle turbinate mucosal flap can replace the pedicled nasal septum mucosal flap,which can reduce the operation time,reduce the postoperative nasal crusting,and increase the patient's nasal comfort.