Woodworth Bradford A, Schlosser Rodney J, Faust Russell A, Bolger William E
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, USA.
Arch Otolaryngol Head Neck Surg. 2004 Nov;130(11):1283-8. doi: 10.1001/archotol.130.11.1283.
Congenital skull base defects have traditionally been treated via an intracranial approach. Recent advances in endoscopic management have made minimally invasive extracranial approaches feasible, with less morbidity.
To determine the success of endoscopic treatment of congenital cerebrospinal fluid leaks and encephaloceles.
Retrospective review of congenital cerebrospinal fluid leaks and encephaloceles treated from January 1, 1992, to December 31, 2003. Data collected include demographic characteristics, presenting signs/symptoms, site of the skull base defect, surgical approach, repair technique, and clinical follow-up.
Eight patients were treated via the endoscopic approach for congenital cerebrospinal fluid leaks and encephaloceles. The average age at presentation was 6 years (range, birth to 18 years). Three patients presented with meningitis (average age, 6 years), 4 had cerebrospinal fluid rhinorrhea, and 3 developed a nasal obstruction. Five defects originated at the foramen cecum, and 3 others involved the ethmoid roof/cribriform plate only. Our endoscopic approaches were successful on the first attempt, with a mean follow-up of 19 months. One patient experienced nasal stenosis postoperatively.
Continuing progress in the surgical management of congenital skull base defects demonstrates that endoscopic repair is a successful alternative to traditional craniotomy approaches, with less morbidity. This technique requires meticulous preparation and precise grafting of the defect to avoid collateral damage to surrounding structures. While reduction in the risk of meningitis, intracranial complications, and facial growth abnormalities and alleviation of nasal obstruction necessitate the timely repair of these skull base defects, special considerations are discussed regarding the optimal timing of surgical intervention, operative working space, and exposure in a smaller nasal cavity.
先天性颅底缺损传统上通过颅内入路进行治疗。内镜治疗的最新进展使微创颅外入路成为可能，且发病率较低。
确定内镜治疗先天性脑脊液漏和脑膨出的成功率。
回顾性分析1992年1月1日至2003年12月31日期间接受治疗的先天性脑脊液漏和脑膨出病例。收集的数据包括人口统计学特征、临床表现、颅底缺损部位、手术入路、修复技术及临床随访情况。
8例患者通过内镜入路治疗先天性脑脊液漏和脑膨出。就诊时的平均年龄为6岁（范围为出生至18岁）。3例患者表现为脑膜炎（平均年龄6岁），4例有脑脊液鼻漏，3例出现鼻塞。5处缺损起源于盲孔，另外3处仅累及筛骨顶/筛板。我们的内镜入路首次尝试即获成功，平均随访19个月。1例患者术后出现鼻狭窄。
先天性颅底缺损手术治疗的持续进展表明，内镜修复是传统开颅手术的一种成功替代方法，且发病率较低。该技术需要对缺损进行细致的准备和精确的植骨，以避免对周围结构造成附带损伤。虽然降低脑膜炎、颅内并发症和面部生长异常的风险以及缓解鼻塞需要及时修复这些颅底缺损，但本文还讨论了关于手术干预的最佳时机、手术操作空间以及在较小鼻腔中的暴露等特殊考虑因素。
