Bayazit Yildirim A, Celenk Fatih, Duzlu Mehmet, Goksu Nebil
Department of Otorhinolaryngology, Gazi University Faculty of Medicine, Ankara, Turkey.
ORL J Otorhinolaryngol Relat Spec. 2009;71(6):329-33. doi: 10.1159/000272030.
To detail our experience in the management of cerebrospinal fluid (CSF) leak following posterior cranial fossa surgery by the retrosigmoid approach.
412 patients who underwent posterior cranial fossa surgery by the retrosigmoid approach for a variety of diseases were included in the study.
There were 32 CSF leaks (7.7%) in the 412 patients. Of these, 16 were leaks from the incision site (50%) and 16 (50%) were CSF rhinorrheas. The CSF leaks were documented in 22 of the vestibular schwannoma surgeries (68.7%) and 10 of the vestibular nerve sectioning surgeries (31.3%). No CSF leak was seen following microvascular decompression and auditory brain stem implantation surgeries. Ten patients could be treated conservatively. Twelve patients needed the placement of a lumbar drainage. Surgical reexploration was performed in 10 patients.
Initially, a conservative treatment should be instituted in the case of a CSF leak. If the conservative treatment fails, the placement of a lumbar drainage should be considered. Patients that do not respond to lumbar drainage require surgical reexploration. The abovementioned algorithm represents the safest and best option in the presence of a CSF leak, as confirmed by the absence of recurrences or multiple revisions in this study.
详细阐述我们采用乙状窦后入路进行后颅窝手术后脑脊液漏的处理经验。
本研究纳入了412例因各种疾病采用乙状窦后入路进行后颅窝手术的患者。
412例患者中有32例发生脑脊液漏（7.7%）。其中，16例为切口部位漏液（50%），16例为脑脊液鼻漏（50%）。22例听神经瘤手术（68.7%）和10例前庭神经切断手术（31.3%）出现脑脊液漏。微血管减压术和听觉脑干植入术后未见脑脊液漏。10例患者可采用保守治疗。12例患者需要放置腰大池引流。10例患者进行了手术探查。
对于脑脊液漏，最初应采取保守治疗。若保守治疗失败，应考虑放置腰大池引流。对腰大池引流无反应的患者需要进行手术探查。如本研究中未出现复发或多次翻修所证实，上述方案是脑脊液漏情况下最安全、最佳的选择。
