Department of Otorhinolaryngology, University of Foggia, Foggia, Italy.
Rhinology. 2009 Dec;47(4):362-8. doi: 10.4193/Rhin08.175.
Endoscopic transnasal approaches to the skull base have revolutionized the treatment of cerebrospinal fluid (CSF) fistulae, making repair less invasive and more effective compared with craniotomy or extracranial techniques.
This study evaluated, retrospectively, the results of endoscopic repair of dural defects with the use of mucoperiostal grafts taken from the lower turbinate.
Between January 1997 and January 2007, 125 cases of anterior skull base CSF fistulae were treated endoscopically at the Instituto Felippu de Otorrinolaringologia, Sao Paolo, Brazil, and at the Department of Otolaryngology of the University Hospital "Ospedali Riuniti", Foggia, Italy. Fistula closure was achieved by overlay apposition of a lower turbinate mucoperiostal graft fixated with fibrin glue and Surgicell.
The etiology of the fistula was accidental trauma in 41 cases, iatrogenic trauma in 29, skull base tumour in 12, and spontaneous in 43. The site of the defect was the sphenoid sinus in 43 patients, the cribriform plate in 42, the anterior ethmoid roof in 21, the posterior ethmoid roof in 17, and the posterior wall of the frontal sinus in 2. The success rate at first attempt was 94.4%; the 7 cases of postoperative recurrent CSF leakage involved patients presenting with spontaneous fistula and elevated intracranial pressure; 5 of these had a body-mass index > 30 and 3 suffered from diabetes mellitus.
In our hands, the success rate of endoscopic fistula repair was high, even in defects larger than 2 cm. Success rates may be further improved with accurate diagnosis of elevated intracranial pressure, a contributing factor to failure of spontaneous fistula repair.
内镜经鼻入路已彻底改变了颅底脑脊液（CSF）瘘的治疗方式，与开颅术或颅外技术相比，其使修复的侵袭性更小，效果更佳。
本研究回顾性评估了使用取自下鼻甲的黏膜骨膜移植物修复硬脑膜缺损的内镜治疗效果。
1997 年 1 月至 2007 年 1 月期间，巴西圣保罗菲力浦耳鼻喉研究所和意大利福贾大学医院耳鼻喉科共对 125 例前颅底 CSF 瘘患者进行了内镜治疗。采用纤维蛋白胶和 Surgicell 固定下鼻甲黏膜骨膜移植物进行重叠覆盖，从而实现瘘口闭合。
瘘的病因分别为：外伤性 41 例，医源性 29 例，颅底肿瘤 12 例，自发性 43 例。缺损部位分别为：蝶窦 43 例，筛板 42 例，前筛顶 21 例，后筛顶 17 例，额窦后壁 2 例。初次尝试的成功率为 94.4%；7 例术后复发性 CSF 漏涉及自发性瘘和颅内压升高的患者；其中 5 例 BMI>30，3 例患有糖尿病。
在我们手中，内镜瘘修复的成功率很高，即使是缺损大于 2cm 的患者也是如此。如果能准确诊断颅内压升高（自发性瘘修复失败的一个促成因素），则成功率可能进一步提高。
