Tabaee Abtin, Kassenoff Tali L, Kacker Ashutosh, Anand Vijay K
Department of Otorhinolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY, USA.
Otolaryngol Head Neck Surg. 2005 Dec;133(6):936-43. doi: 10.1016/j.otohns.2005.07.028.
To determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and without computer assisted surgery.
A review of all patients undergoing endoscopic closure of CSF rhinorrhea at a tertiary care medical center between 1994 and 2003. Charts from the 24 patients were reviewed for indications, location of leak, type of surgical closure, number of prior closure attempts, graft materials, use of computer assisted surgery, complications, and need for revision surgery. Analysis was performed to determine a possible correlation between success of CSF leak repair and use of computer assisted surgery.
The etiology of the leak was previous sinus surgery in 10 patients (41.7%), trauma in 5 patients (20.8%), spontaneous leak in 5 patients (20.8%), and skull base surgery in 4 patients (16.7%). The most common sites of leak were the fovea ethmoidalis in 10 patients (41.7%), cribriform plate in 8 patients (33.3%), and sphenoid sinus in 6 patients (25%). Image guidance was employed in 66.7% (16 patients) of our first attempted repairs. Six patients underwent a total of 9 revision procedures. At last follow-up, 96% of patients had no evidence of CSF rhinorrhea. A comparison of patients in the 2 groups failed to reveal a statistically significant difference in the rate of CSF leak closure.
Endoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. The use of computer assistance may improve the confidence of the surgeon and is a valuable adjunct in this procedure. Our study, however, did not demonstrate an improvement in the rates of successful closure with the use of computer assistance.
确定在有和没有计算机辅助手术的情况下，内镜修复脑脊液鼻漏的结果。
回顾1994年至2003年在一家三级医疗中心接受内镜下脑脊液鼻漏修补术的所有患者。查阅了24例患者的病历，以了解手术指征、漏口位置、手术封闭类型、先前封闭尝试次数、移植材料、计算机辅助手术的使用情况、并发症以及再次手术的必要性。进行分析以确定脑脊液漏修补成功与计算机辅助手术的使用之间是否存在可能的相关性。
漏液的病因是既往鼻窦手术10例（41.7%）、外伤5例（20.8%）、自发性漏液5例（20.8%）、颅底手术4例（16.7%）。最常见的漏口部位是筛骨水平板10例（41.7%）、筛板8例（33.3%）、蝶窦6例（25%）。在我们首次尝试的修复手术中，66.7%（16例）采用了图像引导。6例患者共接受了9次再次手术。在最后一次随访时，96%的患者没有脑脊液鼻漏的迹象。两组患者的比较未发现脑脊液漏闭合率有统计学上的显著差异。
内镜下脑脊液鼻漏修补术是一种微创且非常成功的手术。计算机辅助的使用可能会提高外科医生的信心，并且是该手术中一项有价值的辅助手段。然而，我们的研究并未证明使用计算机辅助能提高成功闭合率。
