Baban Muaid I Aziz, Hadi Mokarbesh, Gallo Stefania, Zocchi Jacopo, Turri-Zanoni Mario, Castelnuovo Paolo
Unit of Otorhinolaryngology, Department of Surgery, School of Medicine, University of Sulaymaniyah, Kurdistan, Iraq.
Unit of Otorhinolaryngology, Prince Mohammed Bin Naser Hospital, Jazan, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2827-2835. doi: 10.1007/s00405-017-4587-7. Epub 2017 Apr 26.
Cerebrospinal fluid (CSF) leaks associated with endoscopic sinus surgery (ESS) are a rare complication related to anatomical and technical factors. The anatomical variations at skull base level are imperative to be detected preoperatively by CT scan to avoid this complication. Identifying the factors playing a role in the incidence of the CSF leaks during and after ESS and the common leak sites. A retrospective review of 24 patients presented with incidental CSF leaks, gathered from 1999 to 2016 was performed. Images interpretation of the skull base area was done using four parameters includes Keros classification, skull base slope, fovea plane and maxillary ethmoid height ratio (MER). Each parameter is classified into three types according to the anatomical configuration, then these parameters scores categorized according to the level of the safety into a level I, II and III, all levels were correlated with each other and with the site of leakage. It was found that the major group presented with the level I and the least group with level III safety, with an evidence of the most unsafe anatomical variation was the least relevant. Parameters measurements revealed that the larger group of the anatomical variation type III was in the MER and the commonest leak site was in the posterior ethmoidal roof. CT scan study of the skull base is crucial in delineating the variations and be a roadmap to proceed safely through the dissection remembering that incidental CSF leaks are multifactorial in etiology.
与鼻内镜鼻窦手术（ESS）相关的脑脊液（CSF）漏是一种与解剖和技术因素有关的罕见并发症。术前必须通过CT扫描检测颅底水平的解剖变异，以避免这种并发症。确定在ESS期间和之后脑脊液漏发生率中起作用的因素以及常见的漏出部位。对1999年至2016年收集的24例偶然发生脑脊液漏的患者进行了回顾性研究。使用四个参数对颅底区域进行图像解读，包括凯罗斯分类、颅底斜率、中央凹平面和上颌筛骨高度比（MER）。每个参数根据解剖结构分为三种类型，然后根据安全级别将这些参数得分分为I级、II级和III级，所有级别相互关联且与漏出部位相关。结果发现，主要组表现为I级安全，最少的组为III级安全，证据表明最不安全的解剖变异相关性最小。参数测量显示，解剖变异III型中较大的组存在于MER中，最常见的漏出部位在后筛窦顶。颅底的CT扫描研究对于描绘变异至关重要，并且是在解剖过程中安全进行的路线图，要记住偶然发生的脑脊液漏病因是多因素的。
