降低后颅窝经迷路手术后脑脊液鼻漏的风险。
Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa.
作者信息
Cooper Matthew W, Ward Bryan K, Sharon Jeffery, Francis Howard W
机构信息
Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
World J Otorhinolaryngol Head Neck Surg. 2021 Mar 6;7(2):82-87. doi: 10.1016/j.wjorl.2021.01.003. eCollection 2021 Apr.
OBJECTIVE
To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.
METHODS
Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.
RESULTS
In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery.
CONCLUSION
Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.
目的
描述一种改良的经迷路手术闭合与重建技术的操作过程及结果，该技术着重于识别和处理脑脊液流向中耳和咽鼓管的潜在通道。
方法
对一组采用该技术重建的经迷路听神经瘤病例进行回顾性研究。
结果
除了使用软组织细致填充潜在通道外，在使用脂肪组织封闭乳突缺损之前，还使用羟基磷灰石水泥密封开放的气房通道。一小群使用该技术的患者的早期结果令人鼓舞，且无伤口感染情况。有1例脑脊液鼻漏与开放的岩尖气房密封不完全有关，在翻修手术中适当实施所述方案后未复发。
结论
对包括开放气房通道在内的脑脊液流出潜在通道进行积极处理，极有可能降低经迷路入路至后颅窝后的鼻漏发生率及翻修手术需求。
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