neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2025-27-3-32-45neurosurgery-1734Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTРеконструкция дефектов твердой мозговой оболочки при эндоскопической транссфеноидальной резекции опухолей селлярной области головного мозгаReconstruction of dural defects after endoscopic transsphenoidal resection of sellar region tumorshttps://orcid.org/0000-0001-7810-2523МатмусаевМ. М.MatmusaevM. M.

Матмусаев Маруф Махсудович.

Япония, 466-8550 Нагоя, Showa-ku, Tsurumai-cho, 65; Республика Узбекистан, 100142 Ташкент, ул. Хумаюн, 40

Maruf M. Matmusayev.

65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; 40 Khumayun St., Tashkent 100142, Republic of Uzbekistan

marufmatmusayev@gmail.comТакеучиК.TakeuchiK.

466-8550 Нагоя, Showa-ku, Tsurumai-cho, 65

65 Tsurumai-cho, Showa-ku, Nagoya 466-8550

https://orcid.org/0000-0003-4130-5380НагатаЮ.NagataYu.

466-8550 Нагоя, Showa-ku, Tsurumai-cho, 65

65 Tsurumai-cho, Showa-ku, Nagoya 466-8550

https://orcid.org/0000-0003-4758-2987КариевГ. М.KarievG. M.

Республика Узбекистан, 100142 Ташкент, ул. Хумаюн, 40; Республика Узбекистан, 100140 Ташкент, ул. Богишамол, 223; Россия, 117198 Москва, ул. Миклухо-Маклая, 6

40 Khumayun St., Tashkent 100142, Republic of Uzbekistan; 223 Bogishamol St., Tashkent 100140, Republic of Uzbekistan; 6 Miklukho-Maklaya St., Moscow 117198, Russia

БабахановБ. Х.BabakhanovB. Kh.

100142 Ташкент, ул. Хумаюн, 40

40 Khumayun St., Tashkent 100142

ХарадаХ.HaradaH.

466-8550 Нагоя, Showa-ku, Tsurumai-cho, 65

65 Tsurumai-cho, Showa-ku, Nagoya 466-8550

https://orcid.org/0000-0002-2484-1360СайтоР.SaitoR.

466-8550 Нагоя, Showa-ku, Tsurumai-cho, 65

65 Tsurumai-cho, Showa-ku, Nagoya 466-8550

Отделение нейрохирургии Высшей школы медицины Университета Нагоя; Республиканский специализированный научно-практический медицинский центр нейрохирургииУзбекистанDepartment of Neurosurgery, Nagoya University Graduate School of Medicine; Republican Specialized Scientific Practical Medical Center of NeurosurgeryUzbekistanОтделение нейрохирургии Высшей школы медицины Университета НагояЯпонияDepartment of Neurosurgery, Nagoya University Graduate School of MedicineJapanРеспубликанский специализированный научно-практический медицинский центр нейрохирургии; Ташкентский педиатрический медицинский институт; ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы»УзбекистанRepublican Specialized Scientific Practical Medical Center of Neurosurgery; Tashkent Pediatric Medical Institute; Peoples' Friendship University of Russia n. a. Patrice LumumbaUzbekistanРеспубликанский специализированный научно-практический медицинский центр нейрохирургииУзбекистанRepublican Specialized Scientific Practical Medical Center of NeurosurgeryUzbekistan2025141020252733245Copyright © Матмусаев М.М., Такеучи К., Нагата Ю., Кариев Г.М., Бабаханов Б.Х., Харада Х., Сайто Р., 20252025Матмусаев М.М., Такеучи К., Нагата Ю., Кариев Г.М., Бабаханов Б.Х., Харада Х., Сайто Р.Matmusaev M.M., Takeuchi K., Nagata Y., Kariev G.M., Babakhanov B.K., Harada H., Saito R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1734Введение

Введение. Эндоскопическая трансназальная транссфеноидальная хирургия (стандартная/расширенная) обычно используется для удаления новообразований в селлярной и параселлярной областях. Однако из-за анатомического расположения этой области послеоперационная назальная ликворея становится одной из основных причин осложнений транссфеноидального доступа. Реконструкция основания черепа после эндоскопической транссфеноидальной хирургии необходима для предотвращения послеоперационной назальной ликвореи.

Цель исследования - определение конкретных рекомендаций и разработка алгоритма дуропластики после удаления опухолей селлярной области головного мозга.

Материалы и методы

Материалы и методы. В исследование были включены данные всех пациентов университетской больницы Нагоя (Япония), которым выполнялась реконструкция турецкого седла с ушиванием твердой мозговой оболочки (ТМО) с использованием абдоминальной ауто-жировой ткани или фасции после удаления опухолей в период с апреля 2013 г. по март 2017 г. с применением стандартного или рас-ширенного эндоскопического транссфеноидального доступа.

Результаты

Результаты. Эндоскопические хирургические вмешательства были выполнены 176 пациентам. У 141 из них использовали стандартный доступ, у 35 пациентов - расширенный доступ. У 76 из этих пациентов была зафиксирована интраоперационная ликворея II и III степени по Esposito. После операции у 3 пациентов наблюдалась назальная ликворея, что составило 1,7 % от общего числа пациентов.

Заключение

Заключение. Ушивание ТМО является надежным методом реконструкции основания черепа, при этом выполнение непрерывного шва считают наиболее эффективным подходом. Нами разработаны дифференцированный подход и алгоритм дуропластики после удаления опухолей в селлярной области в соответствии с местонахождением образований и наличием дефекта ТМО.

Background

Background. Endoscopic transnasal transsphenoidal surgery (standart/extended) is commonly used for resection tumors in the sellar and parasellar regions. However, because of its anatomical location, cerebrospinal fluid leakage (CSF) is a major complication of this approach. Skull base reconstruction after endoscopic transsphenoidal surgery is essential to prevent postoperative CSF leakage.

Aim

Aim. To determine specific recommendations and develop an algorithm for dural reconstruction after tumor removal in the sellar region.

Materials and methods

Materials and methods. All patients who were treated at Nagoya University Hospital from April 2013 to March 2017 who underwent sellar floor reconstruction using dural suturing with abdominal fat or fascia after tumor removal via a standard and extended endoscopic transsphenoidal approach were included in the study.

Results

Results. Endoscopic transsphenoidal surgery was performed in 176 patients (the standard transsphenoidal approach was used for 141 patients and the extended transsphenoidal approach was used for 35 patients). In 76 patients, intraoperative CSF leak was classified as grade 2 and 3 according to Esposito. There were 3 cases of CSF leakage after the surgery (1.7 %).

Conclusion

Conclusion. Dural suturing is a basic and key method of skull base reconstruction, with continuous suturing being the most effective approach. Due to the localization of tumors, we developed a differentiated approach and algorithm for dural reconstruction after tumor removal in the sellar region.

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The authors declare that there are no conflicts of interest present.