Ismahilov E. Improving the effectiveness of endonasal surgical treatment of the patients with nasal cerebrospinal fluid

The research is based on a complex clinical and instrumental study of 90 patients with nasal cerebrospinal fluid. The 1st group (46 people) included patients whose size of the bone defect did not exceed 0.6 cm; the 2nd group included 44 patients with the size of the bone defect more than 0.6 cm. Patients from the 1st group were divided into 2 subgroups. Subgroup 1A consisted of 20 patients who underwent plastic surgery with auto-adipose tissue according to the method we offered (patent № 132428 from 25.02.2019). Subgroup 1B included 26 patients who underwent plastic surgery of the defect of the skull base according to the generally accepted method of "overlay" by using a flap of mucous membrane from the nasal cavity on the feeding vascular leg. Patients from the 2nd group were divided into 2 subgroups. Subgroup 2A included 21 patients who underwent cerebrospinal fluid fistula plastic surgery according to the generally accepted method by using a fragment of the broad fascia of the thigh and subsequent additional closure of the nasal cavity with a naso-septal flap. Subgroup 2B included 23 patients who underwent cerebrospinal fluid fistula plastic surgery according to our offered method (patent № 7795 from 20.01.2020). Experimental studies have been carried out on 56 mature nonlinear rats of both sexes aged 3-6 months with weight 190-275 g. Bone defect plasticity was performed by using autobone and fragment of wide femoral fascia (control group), autobone, fragment of wide fascia of femur and by adding calcium hydroxyapatite in the form of gel (the1st experimental group), and by using autobone, fragment of wide fascia of femur and by adding of hydroxy calcium in the form of gel with modifiers (the 2nd experimental group). It is established that our offered technique of plasticity of using auto adipose tissue can reduce the number of recurrences of nasal cerebrospinal fluid while using endoscopic endonasal access from 19.23% when performing plastic surgery using a flap of mucous membrane from the nasal cavity to 5.0% by using our offered technique. The offered technique of cerebrospinal fluid fistula with bone defect size less than 0.6 cm allows to preserve all intranasal structures and architectonics of the nasal cavity, thereby significantly reducing the number of patients with olfactory disorders, transport function of the ciliated epithelium of the nasal cavity in comparison with the method of mucosal flap from the nasal cavity. Our method of the skull base defects more than 0.6 cm, accompanied by nasal cerebrospinal fluid can reduce the risk of recurrence of cerebrospinal fluid in significantly fewer cases than when using the generally accepted plastic method. Quantitative studies of the callus bone thickness of the studied groups revealed the most evident stimulation of osteosynthesis and closure of the defect when using HAP gel after modification. The thickness of the newly formed bone by the adding only HAP gel in the control group is 20% more in 2 weeks and after 1.5 months – 70%. While if to compare with the data of the group 2 after the application of the modified HAP gel, these indicators significantly exceed those in the control group. The conducted experimental researches are preclinical and can be recommended for the organization of clinical trials.