Kutz Joe Walter, Tolisano Anthony M
Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Curr Opin Otolaryngol Head Neck Surg. 2019 Oct;27(5):369-375. doi: 10.1097/MOO.0000000000000568.
To describe the current state in the diagnosis and management of spontaneous cerebrospinal fluid (sCSF) fistula and encephaloceles.
The increased incidence of obesity has resulted in more cases of sCSF fistula and encephaloceles. Obesity results in increased intracranial pressure and a greater chance of developing a sCSF fistula or encephalocele. Obstructive sleep apnea can also result in transient increase in intracranial pressure and has been shown to be common in patients with sCSF fistula. Treatment of CSF fistula is usually necessary because of the increased risk of meningitis. The use of hydroxyapatite bone cements to repair the temporal bone defects has been described with a high success rate of closing the fistula and a low complication rate. Concurrent superior semicircular canal dehiscent can be seen in up to 15% of cases and should be suspected during the surgical approach to avoid potential sensorineural hearing loss and chronic imbalance.
sCSF fistula and encephaloceles are an uncommon cause of hearing loss, middle ear effusion, and otorrhea, but should be recognized and repaired because of the risk of meningitis.
描述自发性脑脊液（sCSF）瘘和脑膨出的诊断与管理现状。
肥胖发生率的增加导致了更多sCSF瘘和脑膨出病例。肥胖会导致颅内压升高，增加发生sCSF瘘或脑膨出的几率。阻塞性睡眠呼吸暂停也可导致颅内压短暂升高，且已证实在sCSF瘘患者中较为常见。由于脑膜炎风险增加，通常需要治疗脑脊液瘘。已报道使用羟基磷灰石骨水泥修复颞骨缺损，瘘口闭合成功率高且并发症发生率低。高达15%的病例可同时出现上半规管裂，在手术过程中应予以怀疑，以避免潜在的感音神经性听力损失和慢性平衡失调。
sCSF瘘和脑膨出是听力损失、中耳积液和耳漏的罕见原因，但鉴于脑膜炎风险，应予以识别和修复。
