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首页> 外文OA文献 >Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery
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Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery

机译：小儿同时双侧听觉脑干植入手术后可吸收网状颅骨成形术修复双侧脑脊液漏。

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OBJECTIVE:\udTo present a child with cochlear nerve deficiency (CND) who received simultaneous bilateral simultaneous auditory brainstem implants (BS-ABI) and subsequently presented with bilateral cerebrospinal fluid (CSF) leaks unresponsive to standard treatments. To propose a novel rigid retrosigmoid cranioplasty for treating and preventing CSF leaks in children at high risk for this complication.\udPATIENT:\udA 3.5-year-old child with CND, vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities, coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality, Arnold Chiari malformation, previous treated tracheo-esophageal fistula underwent BS-ABI. Postoperatively, the child had recurrent bilateral retroauricular fluid collections. A standard revision procedure revealed breaches in the dural closure, migration of the auditory brainstem implantation (ABI) receiver stimulator on both sides and was unsuccessful in stopping the leak.\udINTERVENTIONS:\udBilateral repair with free fat grafting filling the craniectomy space and two absorbable meshes of poly-L-D-lactic (PLDL) acid stabilized with PLDL pins on the surrounding cranium, one to stabilize the fat graft and one to fix the ABI receiver stimulators inside the subperiosteal pockets.\udMAIN OUTCOME MEASURE:\udCSF leak recurrence, postoperative computed tomographic (CT) scans, intra- and postoperative simultaneous electrically evoked auditory brainstem responses (EABRs). Subjective and objective assessment of ABI function.\udRESULTS:\udNo postoperative CSF leaks at 60 days follow-up. EABRs and consistent behavioral responses obtained at initial mapping on both sides.\udCONCLUSIONS:\udThe use of BS-ABI likely contributed to bilateral CSF leaks requiring revision surgeries in this child. Simultaneous bilateral craniotomies can put patients at risk for CSF leak. A novel cranioplasty technique employed finally proved successful in stopping the CSF leak in this case.
机译：目的：介绍一名患有耳蜗神经缺陷（CND）的儿童，该儿童接受了同时双侧同时听觉脑干植入物（BS-ABI），随后出现了对标准治疗无反应的双侧脑脊液（CSF）泄漏。拟提出一种新颖的刚性乙状结肠后颅成形术，以治疗和预防这种并发症高风险儿童的脑脊液渗漏。\ udPATIENT：\ ud3.5岁的儿童，患有CND，椎体缺损，肛门闭锁，心脏缺损，气管食管瘘，肾异常，肢体异常，大肠癌，心脏缺陷，闭锁性脉管炎，生长发育迟缓，生殖器异常和耳朵异常，Arnold Chiari畸形，先前治疗过的气管-食管瘘管接受了BS-ABI。术后，该患儿反复出现双侧耳廓积液。标准修订程序显示硬膜闭合破裂，听觉脑干植入（ABI）接收器刺激器在两侧迁移且未能成功阻止渗漏。\ ud干预措施：\ ud使用游离脂肪移植物进行双侧修复，可充填颅骨切除术空间，两个可吸收ud-乳酸-乳酸（PLDL）酸网，用周围颅骨上的PLDL销钉固定，一个用于稳定脂肪移植物，另一个用于将ABI受体刺激物固定在骨膜下腔内。\ ud主要观察指标：\ udCSF渗漏复发，术后计算机体层摄影（CT）扫描，术中和术后同时电诱发的听觉脑干反应（EABR）。主观和客观评估ABI功能。\ ud结果：\ ud术后60天随访时无术后CSF渗漏。 EABR和双方在初始映射时均获得一致的行为反应。\ ud结论：\ ud使用BS-ABI可能导致双侧CSF漏出，需要对该儿童进行翻修手术。同时双侧开颅手术可能使患者处于脑脊液漏的风险中。在这种情况下，最终采用的新型颅骨成形术技术成功地阻止了CSF泄漏。

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