Weber Stephen M, Kim Jason, Delashaw Johnny B, Wax Mark K
Department of Otolaryngology and Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
Laryngoscope. 2005 Jun;115(6):968-72. doi: 10.1097/01.MLG.0000163335.05388.8E.
Cerebrospinal fluid (CSF) leaks can occur after head trauma or skull base surgery. Persistent or spontaneous leaks should be repaired, since they put patients at risk for serious intracranial complications. Although numerous repair methods have been successful, the occasional patient develops a persistent leak. We describe our experience with free tissue transfer for repair of recalcitrant CSF leaks.
Retrospective chart review of patients undergoing free tissue transfer for repair of a CSF leak between November 1995 and October 2004. Setting was an academic, tertiary care referral center.
Twelve patients with persistent CSF leak were studied. Eleven of 12 patients had undergone a previous repair attempt ranging from endoscopic repair with fat graft to craniotomy and primary repair of the dural defect. All patients underwent radial forearm free tissue transfer.
There were six female and six male patients. Average age was 52.7 years (range, 22-80 y). The most common presenting complaints were intracranial abscess, recurrent meningitis, or pneumocephalus (n=9) and CSF otorrhea or rhinorrhea (n=8). Cause was head trauma (n=6), prior surgery (n=4), cholesteatoma (n=1), or meningoencephalocele (n=1). Eleven of 12 patients failed prior procedures (range, 0-6 procedures; mean, 1.9). Ten flaps were placed in the anterior skull base and two were in the middle or posterior skull base. Radial forearm free tissue transfer resulted in sustained resolution of CSF leakage in all 12 patients.
Free tissue transfer is an efficacious option in the repair of recalcitrant CSF leaks.
脑脊液（CSF）漏可发生于头部外伤或颅底手术后。持续性或自发性漏应予以修复，因为它们会使患者面临严重颅内并发症的风险。尽管众多修复方法已取得成功，但仍有部分患者会出现持续性漏。我们描述了应用游离组织移植修复顽固性脑脊液漏的经验。
对1995年11月至2004年10月期间接受游离组织移植修复脑脊液漏的患者进行回顾性病历审查。研究地点为一所学术性三级医疗转诊中心。
对12例持续性脑脊液漏患者进行研究。12例患者中有11例曾尝试过修复，范围从内镜下脂肪移植修复到开颅手术及硬脑膜缺损一期修复。所有患者均接受了桡侧前臂游离组织移植。
患者中6例为女性，6例为男性。平均年龄为52.7岁（范围22 - 80岁）。最常见的主诉是颅内脓肿、复发性脑膜炎或气颅（9例）以及脑脊液耳漏或鼻漏（8例）。病因包括头部外伤（6例）、既往手术（4例）、胆脂瘤（1例）或脑膜膨出（1例）。12例患者中有11例既往手术失败（范围0 - 6次手术；平均1.9次）。10个皮瓣置于前颅底，2个置于中颅底或后颅底。桡侧前臂游离组织移植使所有12例患者的脑脊液漏得到持续解决。
游离组织移植是修复顽固性脑脊液漏的一种有效选择。
