DeConde Adam S, Suh Jeffrey D, Ramakrishnan Vijay R
aDepartment of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of California San Diego, San Diego bDepartment of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, California cDepartment of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA.
Curr Opin Otolaryngol Head Neck Surg. 2015 Feb;23(1):59-64. doi: 10.1097/MOO.0000000000000124.
Cerebrospinal fluid (CSF) rhinorrhea is a rare entity that can arise from a variety of causes. Successful management has been reported using a variety of repair techniques. The goal of this study is to make recommendations on intraoperative and postoperative management of CSF fistulas across all causes.
Pooled analysis of case series reveals that free graft repairs are successful in closing most traumatic and iatrogenic CSF leaks. In contrast, multilayered, vascularized repairs are often required for large defects with high-flow leaks that communicate with a cistern and/or ventricles. Spontaneous CSF leaks are associated with idiopathic intracranial hypertension in the vast majority of cases, and when present, postoperative medical management is necessary for long-term success.
Patients with CSF rhinorrhea require surgical repair to prevent life-threatening complications. Many techniques and materials are effective at achieving closure of CSF fistula across causes. Evidence suggests that patients with high-flow CSF fistulas have improved outcomes with multilayered, vascularized repairs to decrease the risk of postoperative CSF leaks. Patients with idiopathic intracranial hypertension need long-term management of the underlying disease process.
脑脊液鼻漏是一种可由多种原因引起的罕见病症。据报道，采用多种修复技术可成功进行治疗。本研究的目的是就各种原因导致的脑脊液瘘的术中及术后管理提出建议。
病例系列的汇总分析表明，游离移植物修复术成功闭合了大多数创伤性和医源性脑脊液漏。相比之下，对于与脑池和/或脑室相通的高流量漏口的大缺损，通常需要进行多层带血管修复。在绝大多数情况下，自发性脑脊液漏与特发性颅内高压相关，一旦出现，术后药物治疗对于长期成功至关重要。
脑脊液鼻漏患者需要手术修复以预防危及生命的并发症。许多技术和材料在闭合各种原因导致的脑脊液瘘方面都有效。有证据表明，高流量脑脊液瘘患者通过多层带血管修复可改善预后，降低术后脑脊液漏的风险。特发性颅内高压患者需要对潜在疾病过程进行长期管理。
