Bubshait Rawan F, Almomen Ali A
Otolaryngology - Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, SAU.
Cureus. 2021 Feb 20;13(2):e13457. doi: 10.7759/cureus.13457.
Introduction Cerebrospinal fluid (CSF) rhinorrhea is the result of a bony defect at the skull base with disruption of the arachnoid, dura mater, and sinonasal mucosa that leads to an active CSF leak and flow of clear fluid from the nose. The endoscopic repair of CSF leaks and skull defects have been used by an increasing number of surgeons and is the standard of care for repairing CSF leaks. Materials and methods We conducted a retrospective study of all cases of CSF leaks managed via the endonasal endoscopic approach from 2010 to 2020 at a tertiary referral hospital of King Fahad Specialist Hospital, Dammam (KFSH-D). Results Over 10 years, 61 procedures were performed on a total of 56 patients (average age, 39.9 years) with 26 spontaneous CSF leaks and 30 traumatic CSF leaks. The leak sites were frontal bone in 14% of the cases, the roof of the ethmoid in 25%, the cribriform plate of ethmoid in 39%, and the walls of sphenoid sinus in 21%; multiple site defects were found in eight patients. The defect was localized by high-resolution computed tomography (CT) of the paranasal sinuses and skull base and magnetic resonance imaging (MRI) in all patients. CT cisternography, intrathecal fluorescein injection, and topical application of fluorescein dye were used in patients as required. A combination of free grafts and flaps materials were used in most patients. A middle and inferior turbinate graft was used in 12 patients, a septal cartilage graft in 18 patients, and a pedicled nasoseptal flap in 12 patients. The success rate was 92% after the first closure attempt. A recurrence of CSF leaks was observed in four patients. The mean hospitalization time was 6.5 days. The postoperative follow-up period ranged from one year to 10 years with a mean postoperative follow-up time of three years. Conclusions The endonasal endoscopic approach is the current standard of care for repairing most CSF leaks and skull base defects. We have had an excellent experience with endonasal endoscopic CSF leak repair, with high success rates and low morbidity. Our results support the effectiveness and safety of this technique and should encourage otolaryngologists to apply the procedure in cases of CSF leak.
引言
脑脊液鼻漏是颅底骨质缺损导致蛛网膜、硬脑膜和鼻窦黏膜破裂，进而引起脑脊液持续漏出并从鼻腔流出清亮液体的结果。越来越多的外科医生采用内镜修复脑脊液漏和颅骨缺损，这是修复脑脊液漏的标准治疗方法。
材料与方法
我们对2010年至2020年在达曼法赫德国王专科医院（KFSH-D）这一三级转诊医院通过鼻内镜入路治疗的所有脑脊液漏病例进行了回顾性研究。
结果
在10年期间，共对56例患者（平均年龄39.9岁）进行了61例手术，其中26例为自发性脑脊液漏，30例为创伤性脑脊液漏。漏口部位：额骨占14%，筛骨顶占25%，筛骨筛板占39%，蝶窦壁占21%；8例患者存在多个部位缺损。所有患者均通过鼻窦和颅底的高分辨率计算机断层扫描（CT）及磁共振成像（MRI）定位缺损部位。根据需要，对患者使用了CT脑池造影、鞘内注射荧光素和局部应用荧光素染料。大多数患者使用了游离移植物和皮瓣材料的组合。12例患者使用了中鼻甲和下鼻甲移植物，18例患者使用了鼻中隔软骨移植物，12例患者使用了带蒂鼻中隔皮瓣。首次闭合尝试后的成功率为92%。4例患者出现脑脊液漏复发。平均住院时间为6.5天。术后随访时间为1年至10年，平均术后随访时间为3年。
结论
鼻内镜入路是目前修复大多数脑脊液漏和颅底缺损的标准治疗方法。我们在鼻内镜修复脑脊液漏方面有很好的经验，成功率高且发病率低。我们的结果支持了该技术的有效性和安全性，应鼓励耳鼻喉科医生在脑脊液漏病例中应用该手术。
