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후두와 뇌병변의 최소침습수술에서 Fibrin Glue의 사용

Minimally Invasive Surgery for Posterior Cranial Fossa Lesions Using Fibrin Glue

계명의대논문집 2000년 19권 1호 p.83 ~ 90
손은익, 김일만, 조성범, 박관규,
소속 상세정보
손은익 (  ) - 계명대학교 의과대학 신경외과학교실
김일만 (  ) - 계명대학교 의과대학 신경외과학교실
조성범 (  ) - 계명대학교 의과대학 신경외과학교실
박관규 (  ) - 계명대학교 의과대학 신경외과학교실

Abstract

다양한 후두와 뇌병변에 대한 수술에서 최소의 하후두골절제술로도 접근이 가능하며, 조직접착
제를 이용한 뇌경막봉합의 보강과 두개골성형술을 시행함으로써, 술후 후두부 골결손에 의한 함
몰과 통증 및 뇌척수액누출로 인한 수술부위의 팽창, 창상감염, 뇌척수액 이비루 및 뇌막염등의
합병증과 후유증을 예방할 수 있을 것으로 생각된다.
#초록#
The posterior fossa surgery(PFS) via lateral suboccipital craniectomy(SOCE) and partial
mastoidectomy always has the potential cerebrospinal fluid(CSF) leakage and painful deformity
in the suboccipital and retroauriculr are. This study describes the efficacy of our methods of
dural closure and cranioplasty to prevent CSF leakage and suboccipital depression respectively
after posterior fossa exploration using retrosigmoid suboccipital approaches.
This techniques were performed in the consecutive 10 patients who underwent PFS in a
park-bench position for different types of lesions. The SOCE and driling of the mastoid
process were done minimally. Following intradural works, dura was closed in a watertight
manner usually using a graft, thereafter reinforeced with GelfoamR and
biological human allogenic fibrin glue (GreenplastR). After augmentation of dural
suture, opened mastoid air cells were bone-waxed and covered with fat graft by anchoring
sutures. For the reconstructive cranioplasty, autologous bone chips and dust obtained at
craniectomy were wrapped with SurgicelR. Then it was replaced to the site of
suboccipital bone defect and GreenplastR was applied on and around the bone
plate.
The age of patients ranged from 33 to 61 years. Five cases of hemifacial spasm have been
undertaken decompression of the facial nerve and four cases of cerebellopontime angle
masses(meningioma, epidermoid, arachnoid cyst, and cerebellar metastasis) were treated by
retrosigmoid approach. Computed tomography and plain cranial films taken a few month later
showed successful and good appearance of the suboccipital and retromastoid area. All patients
made a excellent recovery without any postoperative complications. Preliminary results of up
to 10 months show no CSF leakage nor a persistent headache. There was no adverse
reactions related to fibrin glue. We think that the present technique is a valuable method to
minimize or avoid postoperative CSF leakage and to restore an autologous bone plate in a
cranial defect by piecemal craniectomy.

Suboccipital craniectomy; Dural repair; Cranioplasty; CSF leakage; Fibrin glue; Posteoperative headache;

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