Alexander Nathan S, Chaaban Mohamad R, Riley Kristen O, Woodworth Bradford A
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.
Arch Otolaryngol Head Neck Surg. 2012 May;138(5):471-8. doi: 10.1001/archoto.2012.614.
To highlight concepts critical to achieving successful repair and avoiding intracranial complications in the treatment of cerebrospinal fluid (CSF) leaks from the lateral recess of the sphenoid sinus (LRS).
Outcomes study.
Tertiary referral university hospital.
Eleven patients with LRS CSF leaks from June 2008 to June 2010.
Endoscopic transpterygoid approach and multilayer repair of skull base defect in the LRS.
Recurrence, graft techniques, postoperative intracranial pressure (ICP), and use of ventriculoperitoneal (VP) shunt.
Thirteen CSF leaks originating in the LRS were surgically repaired in 11 patients; 2 patients required bilateral leak repair. The endoscopic transpterygoid approach was used in 12 of 13 repairs. Eight patients had failed attempts at repair prior to presentation (4 endoscopic sphenoidotomies and 4 middle cranial fossa [MCF] approaches). One patient presented with a temporal lobe abscess following hydroxyapatite "obliteration" to seal off the LRS. This required a combined MCF/transpterygoid approach to drain the abscess, remove the encephalocele and hydroxyapatite, and seal the skull base defect. In 2 cases, the LRS was left patent owing to concerns of inadequate mucosal extirpation. The median duration of follow-up was 10.8 months (range, 2-29 months). One patient experienced a failure (2 months after repair), which was successfully sealed on the second attempt. Postoperatively, 5 patients required VP shunts, and 5 were maintained on acetazolamide for elevated ICP (average, 26.7 cm H₂O in 8 patients; presumed elevated in 2 patients).
The current study demonstrated a 92% success rate using the endoscopic transpterygoid approach for LRS skull base defects providing support for routine use in the treatment algorithm. Poor outcomes were observed with previous surgical attempts to obstruct the LRS without repairing the skull base defect.
强调蝶窦外侧隐窝（LRS）脑脊液（CSF）漏治疗中实现成功修复并避免颅内并发症的关键概念。
结果研究。
三级转诊大学医院。
2008年6月至2010年6月期间11例LRS脑脊液漏患者。
经翼点入路内镜手术及LRS颅底缺损的多层修复。
复发情况、移植技术、术后颅内压（ICP）及脑室腹腔（VP）分流术的使用。
11例患者手术修复了13处源于LRS的脑脊液漏；2例患者需要双侧漏口修复。13例修复中有12例采用经翼点入路内镜手术。8例患者在就诊前修复尝试失败（4例内镜下蝶窦切开术和4例中颅窝[MCF]入路）。1例患者在使用羟基磷灰石“填塞”LRS以封闭漏口后出现颞叶脓肿。这需要联合MCF/经翼点入路引流脓肿、切除脑膨出和羟基磷灰石，并封闭颅底缺损。2例患者因担心黏膜切除不充分而使LRS保持开放。中位随访时间为10.8个月（范围2 - 29个月）。1例患者修复失败（修复后2个月），再次尝试成功封闭。术后，5例患者需要VP分流术，5例因ICP升高使用乙酰唑胺治疗（8例患者平均ICP为26.7 cm H₂O；2例患者推测ICP升高）。
本研究表明经翼点入路内镜手术修复LRS颅底缺损成功率为92%，为治疗方案中的常规使用提供了支持。既往手术尝试在未修复颅底缺损的情况下阻塞LRS效果不佳。
