Woodworth Bradford A, Palmer James N
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Curr Opin Otolaryngol Head Neck Surg. 2009 Feb;17(1):59-65. doi: 10.1097/MOO.0b013e3283200017.
Cerebrospinal fluid leaks that occur spontaneously are challenging to manage clinically owing to frequent recurrences following attempted surgical closure. Understanding of the underlying pathophysiology has increased in recent years as we now recognize that the vast majority of these patients demonstrate clinical symptoms and radiographic signs of elevated intracranial pressure. Individuals with this disorder also arise from a distinct demographic group. Increased knowledge of the characteristics of this patient population along with updated medical and surgical management will provide increased success rates in the management of this clinical entity.
Current literature indicates that control of intracranial hyptertension, coupled with endoscopic repair, will improve success rates comparable with other etiologies. Recent information on the underlying pathophysiology of spontaneous cerebrospinal fluid leaks is discussed. Improvement in preoperative identification of radiographic signs of intracranial hypertension (i.e. empty sella), operative technique, and postoperative management of elevated intracranial pressure are also reviewed.
We highlight the demographic characteristics, clinical presentation, radiologic findings, and clinical management of patients with this disorder.
自发性脑脊液漏在临床上难以处理，因为手术修补后经常复发。近年来，随着我们认识到绝大多数此类患者表现出颅内压升高的临床症状和影像学征象，对其潜在病理生理学的理解有所增加。患有这种疾病的个体也来自一个独特的人群。对该患者群体特征的更多了解以及更新的内科和外科治疗方法将提高对这一临床病症的治疗成功率。
当前文献表明，控制颅内高压并结合内镜修复，将提高成功率，与其他病因相当。本文讨论了关于自发性脑脊液漏潜在病理生理学的最新信息。还综述了术前对颅内高压影像学征象（即空蝶鞍）识别的改善、手术技术以及颅内压升高的术后管理。
我们重点介绍了患有这种疾病的患者的人口统计学特征、临床表现、影像学发现和临床管理。
