Song Xiaole, Wang Dehui, Sun Xicai, Liu Quan, Hu Li, Gu Yurong, Zhang Huankang
Department of Otorhinolaryngology.
Research Center, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
J Craniofac Surg. 2018 Jan;29(1):182-187. doi: 10.1097/SCS.0000000000004175.
The aim of this study was to review the management of sinonasal cerebrospinal fluid (CSF) leaks and outcome of endoscopic repairs and to provide experience regarding leaks at the lateral wall of sphenoid sinus and the posterior wall of frontal sinus.
Patients who underwent endoscopic repairs of CSF leaks were reviewed. Characteristics of different etiologies were compared, and prognostic factors were analyzed.
The study included 144 patients with 150 CSF leaks, in which spontaneous leaks account for 55%. Patients with traumatic leaks were significantly younger than those with spontaneous leaks (P = 0.012), and most traumatic leaks occurred in men (P < 0.001). The computed tomography scan showed an overall accuracy of 86.7%. For 17 leaks at the lateral wall of sphenoid sinus, transnasal (29%), transethmoid (24%), and transpterygoid (47%) approaches were used, with a success rate of 75%. For 11 defects at the posterior wall of the frontal sinus, 2 were managed by draf III surgery, and 3 by trephination-assisted procedure successfully. Success rate for primary repair was 95.6%, reaching 100% after a second repairing. Six leaks failed to be repaired included 4 spontaneous leaks, and 3 occurred at the lateral wall of the sphenoid sinus, 4 occurred in patients with elevated body mass index (BMI), 4 had evidence of raised intracranial pressure (ICP).
Repair of leaks at lateral sphenoid sinus and posterior frontal sinus could achieve favorable results via selected endoscopic approaches. The failure of repair was associated with inaccessible leak sites, spontaneous leaks, raised ICP, and elevated BMI.
本研究旨在回顾鼻窦脑脊液（CSF）漏的处理及内镜修复的结果，并提供有关蝶窦外侧壁和额窦后壁漏的经验。
对接受CSF漏内镜修复的患者进行回顾。比较不同病因的特征，并分析预后因素。
该研究纳入了144例患者，共150处CSF漏，其中自发性漏占55%。创伤性漏患者比自发性漏患者明显年轻（P = 0.012），且大多数创伤性漏发生在男性（P < 0.001）。计算机断层扫描显示总体准确率为86.7%。对于蝶窦外侧壁的17处漏，采用经鼻（29%）、经筛窦（24%）和经翼突（47%）入路，成功率为75%。对于额窦后壁的11处缺损，2例采用Draf III手术处理，3例采用钻孔辅助手术成功处理。初次修复成功率为95.6%，二次修复后达到100%。6处漏未能修复，包括4处自发性漏，3处在蝶窦外侧壁，4例患者体重指数（BMI）升高，4例有颅内压（ICP）升高的证据。
通过选择合适的内镜入路，修复蝶窦外侧壁和额窦后壁的漏可取得良好效果。修复失败与漏口难以到达、自发性漏、ICP升高和BMI升高有关。
