Resumen
Introducción: actualmente no hay certeza sobre cuál es el mejor tratamiento para las fístulas espontáneas de líquido cefalorraquídeo (LCR). Este estudio buscó probar la efectividad del colgajo pediculado de cornete medio (CPCM) en el tratamiento de dichas fístulas, localizadas en el piso anterior de la base de cráneo (PABC).
Objetivo: demostrar la disminución en la recidiva de las fístulas espontáneas de LCR en el PABC tratadas mediante CPCM vía endonasal endoscópica.
Material y métodos: estudio de cohorte ambispectivo que incluyó pacientes con fístula de LCR espontánea localizada en el PABC, tratados mediante CPCM y colgajo nasoseptal (CNS) vía endonasal endoscópica en un hospital de tercer nivel del 1 de marzo de 2020 al 28 de febrero de 2023. Se compararon 2 grupos: grupo A: pacientes tratados con CPCM y grupo B: pacientes tratados con CNS. Se calculó chi cuadrada para recidiva, complicaciones y reintervención quirúrgica; se consideró significativa una p < 0.05.
Resultados: el total fue de 13 pacientes. La causa más frecuente fue la espontánea (9 casos). El CPCM se empleó en 7 casos y CNS en 6. En el grupo A la recidiva fue del 42% y en el B del 66% (p = 0.38). Únicamente se reoperó un paciente del grupo A frente a 4 del grupo B (p = 0.05).
Conclusiones: el uso del CPCM tuvo menos casos de recidiva en comparación con el CNS, aunque no fue estadísticamente significativo. La significación estadística para la reintervención del grupo A sugiere que el CPCM puede ser una opción viable para estos pacientes.
Abstract
Background: Currently there is no certainty on which is the best treatment for spontaneous cerebrospinal fluid (CSF) fistulas. This study aimed to test the effectiveness of the pedicled middle turbinate flap (PMTF) in the treatment of said fistulas, located in the anterior skull base floor (ASBF).
Objective: To demonstrate the reduction in recurrence of spontaneous CSF fistulas in the ASBF treated with endoscopic endonasal PMTF.
Material and methods: Ambispective cohort study which included patients with spontaneous CSF fistulas located in the ASBF, treated with PMTF and nasoseptal flap (NSF) by endoscopic endonasal route in a third-level hospital from March 1, 2020, to February 28, 2023. 2 groups were compared: group A, for patients treated with PMTF, and group B, patients treated with NSF. It was calculated chi squared for recurrence, complications and surgical reintervention. A p value < 0.05 was considered significant.
Results: The total was of 13 patients. The most frequent cause was spontaneous (9 cases). PMTF was used in 7 cases and NSF in 6. In group A the recurrence was 42%, and in group B 66% (p = 0.38). Only 1 patient in group A underwent reoperation vs. 4 in group B (p = 0.05).
Conclusions: The use of PMTF has fewer cases of recurrence compared to NSF, even though it was not statistically significant. The statistical significance for reintervention in group A suggests that PMTF may be a viable option for these patients.
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