Lee Ta-Jen, Huang Chi-Che, Chuang Chi-Cheng, Huang Shiang-Fu
Department of Otorhinolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Laryngoscope. 2004 Aug;114(8):1475-81. doi: 10.1097/00005537-200408000-00029.
OBJECTIVES/HYPOTHESIS: Many reports have advocated the feasibility of using an endoscope for the treatment of cerebrospinal fluid (CSF) rhinorrhea and skull base defect, and diversified endoscopic techniques and repairing materials have recently been proposed. This study determined the effectiveness of endoscopic repair of CSF leaks and interpreted the indications of the lumbar drain.
Retrospective follow-up.
A total of 39 patients with CSF rhinorrhea (20 traumatic, 13 iatrogenic, and 6 spontaneous) were treated in one institution over a 10-year period. An underlay procedure was used to make eight (20.5%) repairs by way of a turbinate composite graft (4 patients), turbinate mucosa graft (3 patients), or the Dura Substitute (Preclude) (1 patient). A free turbinate graft with the applied fibrin glue was used to repair the defect by way of an overlay procedure in 23 (59.0%) lesions. Abdominal fat was used to repair the other eight (20.5%) lesions.
Defects in the cribriform plate and anterior ethmoid sinus comprised the majority (61.5%) of all lesions. The successful rates for overlay, underlay, and fat obliteration procedures were 91.3% (21/23), 87.5% (7/8), and 100% (8/8), respectively. There were no statistical difference between underlay and overlay techniques (P = .792, Student's t test). Lumbar drainage was performed in 18 of 39 (46.2%) cases. Most patients required nasal packing (89.7%) and prophylactic parenteral antibiotics (97.4%). CSF rhinorrhea was resolved during the first attempt in 36 of 39 (92.3%) patients. All leaks were successfully repaired after a second attempt. No major complications were encountered.
The endoscopic approach is safe and effective for the treatment of CSF rhinorrhea, even in the cases not successfully treated by previous neurosurgical approaches. Lumbar drain was suggested for defects in the frontal and sphenoid sinus and defects associated with meningocele or encephalocele. Complete exposure of the defect, appropriate selection of a fitting graft, as well as accurate placement and stabilization of the graft are critical to the success of repair.
目的/假设：许多报告主张使用内窥镜治疗脑脊液鼻漏和颅底缺损具有可行性，并且最近已经提出了多种内窥镜技术和修复材料。本研究确定了内窥镜修复脑脊液漏的有效性，并解释了腰大池引流的适应证。
回顾性随访。
在10年期间，一家机构共治疗了39例脑脊液鼻漏患者（20例创伤性、13例医源性和6例自发性）。采用衬里手术，通过鼻甲复合移植物（4例患者）、鼻甲黏膜移植物（3例患者）或硬脑膜替代物（Preclude）（1例患者）进行了8例（20.5%）修复。在23例（59.0%）病变中，采用游离鼻甲移植物并应用纤维蛋白胶通过覆盖手术修复缺损。使用腹部脂肪修复另外8例（20.5%）病变。
筛板和前筛窦的缺损占所有病变的大多数（61.5%）。覆盖、衬里和脂肪填塞手术的成功率分别为91.3%（21/23）、87.5%（7/8）和100%（8/8）。衬里和覆盖技术之间无统计学差异（P = 0.792，Student t检验）。39例患者中有18例（46.2%）进行了腰大池引流。大多数患者需要鼻腔填塞（89.7%）和预防性静脉用抗生素（97.4%）。39例患者中有36例（92.3%）在首次尝试时脑脊液鼻漏得到解决。所有漏口在第二次尝试后均成功修复。未遇到重大并发症。
内窥镜方法治疗脑脊液鼻漏是安全有效的，即使在先前神经外科方法治疗未成功的病例中也是如此。对于额窦和蝶窦的缺损以及与脑膜膨出或脑膨出相关的缺损，建议使用腰大池引流。缺损的完全暴露、合适移植物的正确选择以及移植物的准确放置和固定对于修复的成功至关重要。
