Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland.
Eur Arch Otorhinolaryngol. 2020 Aug;277(8):2243-2249. doi: 10.1007/s00405-020-05938-4. Epub 2020 Apr 6.
The olfactory groove (OG) is a common site of iatrogenic cerebrospinal fluid (CSF) leak during endoscopic sinus surgery. We aimed to evaluate the prevalence of CSF leak during endoscopic removal of osteomas involving the OG and identify CT findings indicating increased risk of this complication.
A retrospective review was conducted of patients operated on for frontoethmoidal osteoma from 11 years in a single institution. A retrospective review of the literature, 1999 to 2019, of perioperative complications in patients operated on for frontoethmoidal osteoma using endoscopic or combined approaches.
Case series: 73 patients were identified including 17 with the OG involvement. The only case of CSF leak occurred in a patient with spongious part of osteoma at the OG. Among six osteomas with spongious component at the OG, one was detached and five had to be drilled down, leaving a small remnant in four. In contrast, all the 11 osteomas with ivory part at the OG were safely detached and completely removed from the OG after debulking. The prevalence of CSF leak was not statistically different between the patients without and with involvement of the OG. Systematic review of the literature: Among the 273 identified patients there were 8 cases of intraoperative CSF leaks (3%) including 2 from the OG (0.7%).
Involvement of the OG does not significantly increase the risk of intraoperative CSF leak. However, this risk may be increased in patients with the spongious part of the tumor attached to the OG.
嗅沟（OG）是内镜鼻窦手术中发生医源性脑脊液（CSF）漏的常见部位。我们旨在评估内镜切除涉及 OG 的骨瘤时发生 CSF 漏的发生率，并确定提示这种并发症风险增加的 CT 发现。
对 11 年来在一家机构接受额筛骨骨瘤手术的患者进行了回顾性研究。对 1999 年至 2019 年期间使用内镜或联合方法接受额筛骨骨瘤手术的患者的围手术期并发症进行了文献回顾性分析。
病例系列：共确定了 73 例患者，其中 17 例涉及 OG。只有一例 CSF 漏发生在 OG 处有骨瘤海绵部分的患者中。在 6 例 OG 处有海绵状成分的骨瘤中，有 1 例骨瘤脱落，5 例骨瘤必须向下钻孔，4 例骨瘤仅留下一小部分。相比之下，OG 处有象牙状部分的所有 11 例骨瘤都可以安全地分离，并在缩小体积后从 OG 完全切除。OG 受累和未受累患者的 CSF 漏发生率无统计学差异。文献系统回顾：在确定的 273 例患者中，有 8 例术中出现 CSF 漏（3%），其中 2 例来自 OG（0.7%）。
OG 的受累不会显著增加术中 CSF 漏的风险。然而，当肿瘤的海绵状部分附着在 OG 上时，这种风险可能会增加。
