Roehm Corrie E, Brown Seth M
Skull Base. 2011 May;21(3):139-46. doi: 10.1055/s-0031-1275241.
Cerebrospinal fluid (CSF) leak closure remains one of the most difficult surgeries for skull base surgeons, particularly with frontal sinus involvement. Technological advances in endoscopic surgery increasingly allow for less morbid approaches to the frontal sinus. We describe a series of patients who underwent endoscopic frontal sinus CSF leak repair utilizing a unilateral approach, to evaluate the utility and outcomes of this method. We performed a retrospective review of four cases in tertiary care centers. Participants included patients with CSF leak involving the frontal sinus. Main outcome measures included cessation of CSF leak and frontal sinus patency. Three patients were closed on the first surgical attempt; one with a communicating hydrocephalus required a revision procedure. Leak etiologies included prior craniotomy for frontal sinus mucopyocele, spontaneous meningoencephalocele, erosion due to mucormycosis, and prior endoscopic sinus surgery. The frontal sinus remained patent in three of four patients. No patients have evidence of a leak at a minimum of 1 year after surgery. The repair of frontal sinus CSF leaks is possible in specific cases with an endoscopic unilateral approach in leaks with multiple etiologies. Surgeons should consider this approach when selecting the appropriate procedure for repair of frontal sinus CSF leaks.
脑脊液（CSF）漏的封闭仍然是颅底外科医生面临的最具挑战性的手术之一，尤其是涉及额窦的情况。内镜手术的技术进步越来越多地使得对额窦采用创伤较小的手术方式成为可能。我们描述了一系列采用单侧入路进行内镜下额窦脑脊液漏修补术的患者，以评估该方法的实用性和效果。我们对三级医疗中心的4例病例进行了回顾性研究。参与者包括额窦脑脊液漏患者。主要观察指标包括脑脊液漏停止和额窦通畅情况。3例患者首次手术尝试即成功封闭漏口；1例交通性脑积水患者需要进行修复手术。漏口病因包括既往因额窦黏液囊肿行开颅手术、自发性脑膜脑膨出、毛霉菌病侵蚀以及既往内镜鼻窦手术。4例患者中有3例额窦保持通畅。所有患者术后至少1年无脑脊液漏迹象。对于多种病因导致的额窦脑脊液漏，在内镜下单侧入路的特定病例中修复是可行的。外科医生在选择修复额窦脑脊液漏的合适手术方式时应考虑这种方法。
