Teachey William, Grayson Jessica, Cho Do-Yeon, Riley Kristen O, Woodworth Bradford A
Department of Otolaryngology , University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
Department of Neurosurgery , University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
Laryngoscope. 2017 Sep;127(9):2011-2016. doi: 10.1002/lary.26612. Epub 2017 May 16.
OBJECTIVES/HYPOTHESIS: Spontaneous cerebrospinal fluid (CSF) leaks are associated with increased intracranial pressure (ICP) and considered a manifestation of idiopathic intracranial hypertension. Although postoperative acetazolamide and placement of CSF shunt systems are considered valuable interventions for elevated ICP, the impact on recurrence rate remains unclear. The objective of this study was to systematically review evidence from reported literature to evaluate whether postoperative ICP management reduces recurrence rates after primary endoscopic repair.
Prospective case series and systematic review.
Demographics, defect location, success rates, and ICP management in spontaneous CSF leak patients were prospectively collected over 8 years. A search was also conducted in PubMed to identify studies reporting cases of spontaneous CSF rhinorrhea.
Fifty-six articles with nonduplicated data were identified and combined with a prospective series of 108 patients for a total of 679 patients treated for spontaneous CSF rhinorrhea. Average age was 50.4 years with 77% female. Average body mass index was 35.8 kg/m . Defects were most commonly located in the sphenoid sinus (n = 334) followed by the ethmoid (n = 318) and the frontal sinus (n = 46). Successful primary repair was 92.82% in patient cohorts where ICP evaluation and intervention with acetazolamide or CSF shunt systems was performed, but was significantly decreased to 81.87% in series with no active management of elevated ICP (P < .001).
Evaluation and intervention for elevated ICP in spontaneous CSF leaks is associated with significantly improved success rates following primary endoscopic repair.
目的/假设：自发性脑脊液（CSF）漏与颅内压（ICP）升高相关，被认为是特发性颅内高压的一种表现。尽管术后乙酰唑胺和脑脊液分流系统的置入被认为是治疗ICP升高的有效干预措施，但其对复发率的影响仍不明确。本研究的目的是系统回顾已发表文献中的证据，以评估术后ICP管理是否能降低初次内镜修复后的复发率。
前瞻性病例系列研究和系统评价。
前瞻性收集8年间自发性CSF漏患者的人口统计学资料、缺损部位、成功率及ICP管理情况。同时在PubMed上进行检索，以确定报道自发性脑脊液鼻漏病例的研究。
共识别出56篇无重复数据的文章，并与108例患者的前瞻性系列研究合并，共有679例患者接受了自发性脑脊液鼻漏治疗。平均年龄为50.4岁，女性占77%。平均体重指数为35.8kg/m²。缺损最常见于蝶窦（n = 334），其次是筛窦（n = 318）和额窦（n = 46）。在进行了ICP评估并采用乙酰唑胺或脑脊液分流系统进行干预的患者队列中，初次修复成功率为92.82%，但在未积极处理ICP升高的系列研究中，成功率显著降至81.87%（P < .001）。
自发性CSF漏患者中，对ICP升高进行评估和干预与初次内镜修复后的成功率显著提高相关。
4。《喉镜》，127:2011 - 2016，2017年。
