Bhavana Kranti, Kumar Raj, Keshri Amit, Aggarwal Sushil
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Neurol Surg B Skull Base. 2014 Jun;75(3):183-6. doi: 10.1055/s-0033-1363503. Epub 2014 Mar 3.
Objective Cerebrospinal fluid (CSF) leaks from the frontoethmoid and sphenoid region can be easily dealt with endoscopic approaches, but CSF rhinorrhea due to frontal sinus fractures are difficult to treat solely by the nasal endoscopic approach and may require external repair. The technique described targets defects of the posterior table of the frontal sinus where conventional osteoplastic approach of obliteration is usually done. This technique is minimally invasive and involves repair using an endoscope via a frontal trephine. Methods We have treated five cases of traumatic CSF rhinorrhea with this technique, and the mean follow-up is 1 year (range: 10-14 months). The frontal sinus is opened by making a small stab incision (frontal trephine), and the defect site is localized by visualization via endoscope through the trephine. The repair is then performed with fat, bone graft, and fibrin glue. Results Closure of the defect was achieved in a single stage in all the patients, and none of them had a recurrence of leak in the 1-year follow-up period. Conclusion This is a good technique for superiorly and laterally placed posterior table defects of the frontal sinus with minimal morbidity and excellent closure rates.
目的 额筛窦和蝶窦区域的脑脊液（CSF）漏可通过内镜方法轻松处理，但因额窦骨折导致的脑脊液鼻漏仅通过鼻内镜方法难以治疗，可能需要外部修复。所描述的技术针对额窦后板的缺损，而传统的骨成形闭塞方法通常用于此处。该技术微创，通过额骨钻孔经内镜进行修复。方法 我们用该技术治疗了5例创伤性脑脊液鼻漏患者，平均随访1年（范围：10 - 14个月）。通过小切口（额骨钻孔）打开额窦，通过钻孔经内镜可视化定位缺损部位。然后用脂肪、骨移植和纤维蛋白胶进行修复。结果 所有患者均一期实现缺损闭合，在1年随访期内均无漏液复发。结论 对于额窦后板上外侧位置的缺损，这是一种很好的技术，发病率极低且闭合率极佳。
