Schoentgen Clement, Henaux Pierre Louis, Godey Benoit, Jegoux Franck
Department of Oto-rhino-laryngology, Head and Neck Surgery, France.
Acta Otolaryngol. 2013 Sep;133(9):944-50. doi: 10.3109/00016489.2013.793821.
Anterior skull base cerebrospinal fluid (CSF) leak should be surgically repaired with an endonasal approach first for less morbidity. Pretherapeutic topographical diagnosis increases the success rate of surgical repair.
We aimed to evaluate our efficiency in taking care of post-traumatic anterior skull base CSF leak, since no consensual algorithms for diagnosis and treatment have been established.
Data from 40 patients treated for post-traumatic CSF leak of the anterior skull base between January 1997 and December 2008 were retrospectively reviewed. Twenty-nine patients were treated with surgery, with an endonasal approach in 14 patients and a neurosurgical approach in 15 patients. A wait and see policy was applied in 11 patients.
The overall risk of reccurence was 22.5%. Recurrence was represented by the presence of CSF rhinorrhea in 12.5% and the appearance of meningitis in 10% of patients. The overall risk of postoperative anosmia was 27.5%. A wait and see policy led to a higher risk of developing meningitis than surgical repair (p = 0.0003). The absence of pretherapeutic topographical diagnosis led to a higher risk of recurrence of CSF rhinorrhea (p = 0.01). The endonasal approach resulted in less postoperative anosmia (p = 0.006).
前颅底脑脊液漏应首选经鼻入路手术修复，以降低发病率。治疗前的定位诊断可提高手术修复成功率。
由于尚未建立公认的诊断和治疗算法，我们旨在评估我们处理创伤后前颅底脑脊液漏的效率。
回顾性分析1997年1月至2008年12月间40例创伤后前颅底脑脊液漏患者的资料。29例患者接受手术治疗，其中14例采用经鼻入路，15例采用神经外科入路。11例患者采用观察等待策略。
总体复发风险为22.5%。复发表现为脑脊液鼻漏占12.5%，脑膜炎占10%。术后嗅觉丧失的总体风险为27.5%。观察等待策略导致发生脑膜炎的风险高于手术修复（p = 0.0003）。治疗前未进行定位诊断导致脑脊液鼻漏复发风险更高（p = 0.01）。经鼻入路术后嗅觉丧失较少（p = 0.006）。
