Li Mingxian, Mao Song, Tang Ru, Lin Hai, Li Dawei, Ye Haibo, Su Kaiming, Chen Zhengnong, Zhang Weitian
Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
J Craniofac Surg. 2019 Sep;30(6):1657-1661. doi: 10.1097/SCS.0000000000005402.
As delayed diagnosis and treatment of cerebrospinal fluid (CSF) leakage are common in current practice, this study was performed to determine associated factors and discuss appropriate strategies to deal with these problems. A retrospective analysis of all cases of CSF leakage in our hospital from 2007 to 2018, including 41 patients with CSF rhinorrhea and 5 with CSF otorhinorrhea, was performed. Symptoms, associated diseases, misdiagnoses, history of skull base repair surgical, previous medical costs, and number of hospital visits before visiting our institution were reviewed. The diagnoses, surgical reconstruction methods, and prognoses of the patients were analyzed. In 18 patients, CSF leakage was spontaneous, in 14 the cause was trauma, and in the remaining 14 the origin was iatrogenic. Twelve patients had been misdiagnosed with allergic rhinitis, rhinosinusitis, or otitis media. Twelve cases had intracranial infection and 14 suffered airway infection. Six had undergone unsuccessful craniotomy, endonasal endoscopic surgery, or ear surgery for treatment of CSF leakage before visiting our institute. This resulted in an average of 5.13 ± 1.32 referrals and medical costs of up to 20,795.7 ± 4553.80 RMB. The success rate was 97.83% after repairing CSF fistulae in our hospital. The septal floor flap (SFF) method (based on ethmoidal arteries) to treat CSF rhinorrhea showed a success rate of 100% in 12 patients. Therefore, early localization, clinical diagnosis, and appropriate repair surgery can avoid the occurrence of delayed events. Pedicled flaps, including SFF, are recommended to manage challenging CSF rhinorrhea.
由于目前临床上脑脊液漏的诊断和治疗延迟情况较为常见，本研究旨在确定相关因素并探讨应对这些问题的合适策略。对我院2007年至2018年所有脑脊液漏病例进行了回顾性分析，其中包括41例脑脊液鼻漏患者和5例脑脊液耳鼻漏患者。回顾了患者的症状、相关疾病、误诊情况、颅底修复手术史、既往医疗费用以及来我院就诊前的就诊次数。分析了患者的诊断、手术重建方法及预后情况。18例患者脑脊液漏为自发性，14例病因是外伤，其余14例起源于医源性。12例患者曾被误诊为过敏性鼻炎、鼻窦炎或中耳炎。12例发生颅内感染，14例发生气道感染。6例患者在来我院之前接受过治疗脑脊液漏的开颅手术、鼻内镜手术或耳部手术但未成功。这导致平均转诊5.13±1.32次，医疗费用高达20795.7±4553.80元人民币。我院修复脑脊液瘘后的成功率为97.83%。采用基于筛动脉的鼻中隔底瓣（SFF）法治疗脑脊液鼻漏，12例患者成功率达100%。因此，早期定位、临床诊断和适当的修复手术可避免延迟事件的发生。推荐使用带蒂皮瓣，包括SFF，来处理具有挑战性的脑脊液鼻漏。
