Department of Otolaryngology-Head & Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A.
Department of Opthalmology/Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A.
Laryngoscope. 2021 Jan;131(1):41-47. doi: 10.1002/lary.28720. Epub 2020 May 13.
A higher incidence of recurrent cerebrospinal fluid (CSF) leaks has been reported with idiopathic CSF leaks. A growing number of institutions advocate for routine use of intracranial pressure-lowering adjunct treatments after endoscopic repair. We report our results in a patient cohort in which only symptomatic patients are subjected to further testing and treatment.
Retrospective review.
A retrospective review of patients who underwent endoscopic transnasal repair of idiopathic CSF rhinorrhea was performed at the University of Miami, Florida, from July 2010 to July 2017. The database was queried for demographical data, surgical details, radiological findings, and postoperative outcomes. Only patients with greater than a 12-month follow-up were included.
Thirty-three patients underwent endoscopic repair of an idiopathic CSF leak. Twenty-six (79%) were females, with an average age of entire study population being 48 years. The average body mass index (BMI) of the cohort was 33 kg/m , with 89% being overweight (BMI > 25 kg/m ). The skull base defect was found to be mainly at the cribriform plate (64%) and sphenoid sinus (30%). Endoscopic repair was performed successfully as a single repair in 32 patients (97%). The average follow-up was 47 months. Postoperative adjunct medications were used on four patients (12%) with symptomatic idiopathic intracranial hypertension.
Endoscopic repair of idiopathic CSF leaks was found to have a high rate of success in our study. Postoperatively, only four patients required additional measures to medically reduce symptomatic intracranial hypertension. Routine postoperative adjunct treatments are unnecessary and may expose patients to adverse long-term side effects.
4 Laryngoscope, 131:41-47, 2021.
与特发性脑脊液漏相比，复发性脑脊液（CSF）漏的发生率更高。越来越多的机构主张在经内镜修复后常规使用降低颅内压的辅助治疗。我们报告了在一组仅对有症状的患者进行进一步检查和治疗的患者中取得的结果。
回顾性研究。
对 2010 年 7 月至 2017 年 7 月在佛罗里达州迈阿密大学接受内镜经鼻修复特发性脑脊液鼻漏的患者进行了回顾性分析。对数据库进行了查询，以获取人口统计学数据、手术细节、影像学发现和术后结果。仅纳入随访时间超过 12 个月的患者。
33 例患者接受了内镜修复特发性 CSF 漏。26 例（79%）为女性，整个研究人群的平均年龄为 48 岁。该队列的平均体重指数（BMI）为 33kg/m ，89%超重（BMI＞25kg/m ）。颅底缺陷主要位于筛板（64%）和蝶窦（30%）。32 例（97%）患者成功进行了单一修复的内镜修复。平均随访时间为 47 个月。术后有 4 例（12%）有症状性特发性颅内压增高的患者使用了辅助药物。
在我们的研究中，内镜修复特发性 CSF 漏的成功率很高。术后仅 4 例患者需要采取额外措施来降低有症状的颅内压。常规术后辅助治疗是不必要的，并且可能使患者暴露于长期不良反应的风险之下。
4 级喉镜，131：41-47，2021。
