Harvey Richard J, Smith Jacob E, Wise Sarah K, Patel Sunil J, Frankel Bruce M, Schlosser Rodney J
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Am J Rhinol. 2008 Sep-Oct;22(5):516-21. doi: 10.2500/ajr.2008.22.3223.
Endoscopic skull base reconstruction (ESBR) has been widely accepted in the management of cerebrospinal fluid (CSF) leaks. However, it is not the CSF leak itself but the potential for life-threatening intracranial complications (ICCs) that is of primary clinical concern. The risk of developing complications, such as meningitis, in a skull base defect is unknown. Many ESBR are multilayered soft tissue repairs, and long-term prevention of ICCs is not well described.
Retrospective chart review and telephone consultation was used to assess patients who had an ESBR from 2002 to 2008. The incidence of an ICCs (meningitis, cerebral abscess, and pneumocephalus) and associated risk factors were assessed before and after surgery.
One hundred six patients underwent ESBR (mean age (+/-SD), 47.7 +/- 18.5 years; range, 2-78 years) with 95.3% long-term follow-up (mean, 19.9 +/- 16.3 months). ICCs occurred in 21.7% of patients at presentation, in 2.8% of patients during the perioperative period (<2 weeks), and in one patient (0.9%) during the postoperative period. Risk factors for presenting with an ICC and meningitis were revision cases performed elsewhere (chi(2) = 9.10; p = 0.007) and leaking encephaloceles (chi(2) = 5.98; p = 0.014). Factors not associated with increased ICC were an active CSF leak at presentation (chi(2) = 3.03; p = 0.082) and previous radiotherapy.
ESBR offers an excellent long-term option in preventing subsequent ICC with low perioperative complications. ESBR is robust with delayed (>2weeks) CSF leakage occurring in only 1.9% regardless of etiology. The presence of identifiable risk factors for ICC may guide the surgeon in determining the urgency of ESBR.
内镜下颅底重建术（ESBR）在脑脊液（CSF）漏的治疗中已被广泛接受。然而，临床上主要关注的并非脑脊液漏本身，而是危及生命的颅内并发症（ICCs）的发生可能性。颅底缺损发生并发症（如脑膜炎）的风险尚不清楚。许多ESBR是多层软组织修复，对于ICCs的长期预防尚无详尽描述。
采用回顾性病历审查和电话咨询的方式，对2002年至2008年接受ESBR的患者进行评估。在手术前后评估ICCs（脑膜炎、脑脓肿和气颅）的发生率及相关危险因素。
106例患者接受了ESBR（平均年龄（±标准差），47.7±18.5岁；范围，2 - 78岁），长期随访率为95.3%（平均，19.9±16.3个月）。ICCs在21.7%的患者初诊时出现，在2.8%的患者围手术期（<2周）出现，在1例患者（0.9%）术后出现。初诊时伴有ICCs和脑膜炎的危险因素为在其他地方进行的翻修病例（χ² = 9.10；p = 0.007）和漏出性脑膨出（χ² = 5.98；p = 0.014）。与ICCs增加无关的因素为初诊时活动性脑脊液漏（χ² = 3.03；p = 0.082）和既往放疗。
ESBR在预防后续ICCs方面提供了一个良好的长期选择，围手术期并发症发生率低。ESBR效果可靠，无论病因如何，延迟（>2周）脑脊液漏发生率仅为1.9%。ICCs可识别危险因素的存在可能有助于外科医生确定ESBR的紧迫性。
