Martin Timothy J, Loehrl Todd A
Department of Otolaryngology and Communication Sciences, Division of Rhinology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Curr Opin Otolaryngol Head Neck Surg. 2007 Feb;15(1):35-9. doi: 10.1097/MOO.0b013e3280123fce.
The purpose of this review is to discuss endoscopic management of cerebrospinal fluid leaks and to highlight recent advances in both outcomes and technique.
Endoscopic techniques targeting the repair of skull-base defects have evolved as instrumentation for intranasal use has developed. The principles of endoscopic repair mirror those of open repair, with emphasis placed on site identification, site preparation, accurate graft placement and postoperative management. Several patient factors will affect the surgical and medical care of patients with cerebrospinal fluid rhinorrhea, including location, cause and overall medical condition. Numerous techniques have been described and large series attest to high success rates. The use of radiographic image-guidance systems promises to advance localization of the leak site. Endoscopic repair of cerebrospinal fluid leaks remains an accurate and complete method for the repair of cerebrospinal fluid leaks with decreased operative morbidity.
Endoscopic repair of anterior skull-base defects has a high success rate and markedly decreased morbidity as compared with traditional intracranial approaches. The endoscopic approach should be considered the technique of choice for repair of most cerebrospinal fluid fistulae and skull-base defects.
本综述旨在探讨脑脊液漏的内镜治疗方法，并重点介绍在治疗效果和技术方面的最新进展。
随着鼻内使用器械的发展，针对颅底缺损修复的内镜技术也不断演进。内镜修复的原则与开放修复相似，重点在于部位识别、部位准备、精确移植物放置和术后管理。几个患者因素会影响脑脊液鼻漏患者的手术和医疗护理，包括漏口位置、病因和整体健康状况。已经描述了多种技术，大量病例系列证明成功率很高。使用放射影像引导系统有望提高漏口部位的定位准确性。内镜修复脑脊液漏仍然是一种准确且完整的修复方法，可降低手术发病率。
与传统的颅内手术方法相比，内镜修复前颅底缺损成功率高，发病率明显降低。内镜手术应被视为修复大多数脑脊液瘘和颅底缺损的首选技术。
