Woodworth Bradford A, Prince Anthony, Chiu Alexander G, Cohen Noam A, Schlosser Rodney J, Bolger William E, Kennedy David W, Palmer James N
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104-4206, USA.
Otolaryngol Head Neck Surg. 2008 Jun;138(6):715-20. doi: 10.1016/j.otohns.2008.02.010.
To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes.
Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical follow-up.
Fifty-six patients underwent repair of spontaneous CSF leaks. Eighty-two percent (46 of 56) were obese (average BMI 36.2 kg/m(2)). Nine patients had multiple CSF leaks. Fifty-four patients (96%) had associated encephaloceles. Fifty-three CSF leaks (95%) were successfully repaired at first attempt (34 months of follow-up). Intracranial pressures averaged 27 cm H(2)O. Patients were treated with acetazolamide or, in severe cases, with a ventriculoperitoneal shunt.
Spontaneous CSF leaks have the highest recurrence rate of any etiology. With treatment of underlying intracranial hypertension coupled with endoscopic repair, the success rate (95%) approaches that of other etiologies of CSF leaks.
报告我们修复自发性脑脊液（CSF）漏的结果，并展示如何通过处理潜在的颅内高压来改善治疗结果。
对1996年至2006年在宾夕法尼亚大学医疗系统治疗的自发性CSF漏进行回顾性研究。收集的数据包括人口统计学资料、临床表现、体重指数（BMI）、颅底缺损部位、手术入路、颅内压及临床随访情况。
56例患者接受了自发性CSF漏修复术。82%（56例中的46例）为肥胖患者（平均BMI 36.2 kg/m²）。9例患者存在多处CSF漏。54例患者（96%）伴有脑膨出。53例CSF漏（95%）首次尝试修复成功（随访34个月）。颅内压平均为27 cm H₂O。患者接受乙酰唑胺治疗，严重病例则采用脑室腹腔分流术治疗。
自发性CSF漏在所有病因中复发率最高。通过处理潜在的颅内高压并结合内镜修复，成功率（95%）接近CSF漏其他病因的成功率。
