The Results of Using the Method of Bipolar High-frequency Electric Welding to Close Defects of the Dura Mater in Frontal Sinus Tumors with Intracranial Spread, and its Comparison with the Standard Method
The frequency of cerebrospinal fluid leak (CSFL) in the postoperative period after surgical interventions on the structures of the skull base reaches 6.2%, and after interventions on the structures of the anterior cranial fossa - 5.9%, middle cranial fossa - 6.4% and - 5.8% in all subtentorial interventions (Jamshidi, 2022; Rajendran, 2020). The aim of the study is to increase the effectiveness of surgical treatment of patients with tumors of the frontal sinuses with intracranial spread by using the method of high-frequency bipolar electric welding. Depending on the method of dura mater defect repair, patients were divided into 2 groups. The 1st group (control) included patients whose dura mater defect was connected according to the conventional method (suturing with polypropylene threads). In the 2nd group – the dura mater defect was connected by high-frequency bipolar electric welding. Patients of the 1st and 2nd groups were divided into 2 subgroups. Subgroups 1A and 2A included patients in whom the DM defect was up to 3 cm in diameter and linear; if necessary, a pericranium was used to close the DM defect. Subgroups 1B and 2B included patients in whom the connection of the defect was performed with the help of a fascia lata. As a result of the study, the authors proposed an effective method of connecting the dura mater defects after the removal of frontal sinus tumors spreading intracranially. Such methods include a high-frequency bipolar electric welding method, the use of which contributed to a minimal destructive effect on adjacent tissues but at the same time hermetically connected the dura mater. Presented data indicate that the use of high-frequency bipolar electric welding allowed to reduce the frequency of external CSFL by 2.2 times, compared to the use of suture material, and to reduce of hidden CSFL by 4.6 times, which indicates a statistically significant advantage of using high-frequency bipolar electric welding to close DM defects and prevent the occurrence of external and hidden CSFL in the postoperative period. In the presence of a DM defect of more than 3 cm and when it is closed with the fascia lata, it is possible to reduce the occurrence of external CSFL by 2.0 times compared to the control group. The use of high-frequency bipolar electric welding almost completely reduces the possibility of the formation of a meningeal scar in the postoperative period, which significantly accelerates the recovery of CSFL circulation and the recovery of brain tissue (due to the absence of factors that would irritate it), as a result of which the patient's rehabilitation and recovery are faster, compared to standard methods of connecting DM. The use of high-frequency bipolar electric welding was manifested by a faster recovery of normal intracranial pressure indicators - a faster recovery of fluid dynamics, a faster regression of inflammatory changes in the brain tissue and, as a result, a faster recovery of its functions, which indicates a higher quality of life of postoperative patients in the main group, compared to the control group.