Alameda Yadiel A, Busquets José M, Portela Juan C
Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico, San Juan, Puerto Rico 00936-5067.
Bol Asoc Med P R. 2009 Apr-Jun;101(2):29-33.
The surgical management of anterior skull base cerebrospinal fluid (CSF) fistulas has evolved throughout the last decade. Endonasal endoscopic surgery of the anterior skull base has become the standard procedure for the repair of most these fistulas.
To describe the presenting symptoms, etiology, treatment, and long-term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. MATERIAL/ METHODS: Retrospective analysis of 25 patients with CSF fistulas treated endoscopically at the University of Puerto Rico Hospital from November 2004 to August 2008.
The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in one patient, and trauma in one patient. The most common location of leak was the cribiform plate, followed by the ethmoid roof. An overlay technique was used for repair in 61% of the procedures versus 39% for the underlay technique. The mean follow up was 23 months. Our overall initial rate of closure was 94% with 100% after a second procedure.
Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.
过去十年间，前颅底脑脊液漏的外科治疗方法不断发展。鼻内镜下前颅底手术已成为修复大多数此类瘘管的标准术式。
描述在我院接受内镜治疗的前颅底脑脊液漏患者的临床表现、病因、治疗及长期预后。材料/方法：回顾性分析2004年11月至2008年8月在波多黎各大学医院接受内镜治疗的25例脑脊液漏患者。
病因包括10例自发性漏、7例脑膜脑膨出、1例既往鼻窦手术史及1例外伤。最常见的漏口部位是筛板，其次是筛窦顶。61%的手术采用覆盖技术修复，39%采用衬里技术。平均随访23个月。我们的总体初始闭合率为94%，二次手术后为100%。
与开放手术相比，内镜修复前颅底脑脊液漏成功率高，发病率和死亡率低。
