Van Zele T, Dewaele F
B-ENT. 2016;Suppl 26(2):19-27.
Traumatic CSF leaks of the anterior skull base. Skull base fractures are a frequent complication of high-impact trauma; due to the inherent anatomic relationships of the skull base, they may be associated with significant intracranial complications, including CSF leakage, and their detection is therefore important. The ethmoid roof and the cribriform plate region are the sites most vulnerable to fractures and dural tears. Rhinorrhoea is a non-specific finding; the presence of CSF in a sample must be confirmed with beta 2 transferin or beta trace protein. Accurate identification of the leakage site is necessary for a successful surgical treatment. Various modalities are available for this purpose, such as CT scan and MRI. Persistent CSF rhinorrhoea necessitates surgical intervention, due to the risk of meningitis. Continued improvements in endoscopic reconstruction techniques have led to fewer open surgeries for repair. Smaller defects can be closed with fat gasket technique or free grafts, while larger defects necessitate a multilayer closure with local vascularized flaps. These techniques have shown consistently high success rates.
前颅底创伤性脑脊液漏。颅底骨折是高冲击力创伤的常见并发症;由于颅底固有的解剖关系,它们可能与包括脑脊液漏在内的严重颅内并发症相关,因此其检测很重要。筛骨顶板和筛板区域是最易发生骨折和硬脑膜撕裂的部位。鼻漏是一种非特异性表现;样本中脑脊液的存在必须用β2转铁蛋白或β微量蛋白来确认。准确识别漏出部位对于成功的手术治疗是必要的。为此有多种方式可供选择,如CT扫描和MRI。由于存在脑膜炎风险,持续性脑脊液鼻漏需要手术干预。内镜重建技术的不断改进使得开放性修复手术减少。较小的缺损可用脂肪垫技术或游离移植物封闭,但较大的缺损则需要用局部带血管蒂皮瓣进行多层封闭。这些技术一直显示出很高的成功率。