Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia.
Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore 119077, Singapore.
Int J Environ Res Public Health. 2022 Oct 25;19(21):13847. doi: 10.3390/ijerph192113847.
Cerebrospinal fluid (CSF) rhinorrhea requires proper management to avoid disastrous consequences. The objectives of this study were to ascertain the patient characteristics, etiologies, sites of defect, skull base configurations, methods of investigation, and management outcomes of CSF rhinorrhea.
A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients' characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes.
A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9/15 cases). The mean ± SD of the Keros heights were 4.43 ± 1.66 (right) and 4.21 ± 1.76 mm (left). Type II Keros was the most common (60%). The mean ± SD angles of the cribriform plate slope were 51.91 ± 13.43 degrees (right) and 63.54 ± 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean ± SD postoperative hospital stay was 9.07 ± 6.17 days.
Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.
脑脊液（CSF）鼻漏需要进行适当的管理，以避免灾难性的后果。本研究的目的是确定 CSF 鼻漏患者的特征、病因、漏口部位、颅底结构、检查方法和治疗效果。
对来自马来西亚、新加坡和泰国的三位外科医生进行了一项为期 4 年的回顾性研究。查阅医院病历以确定患者的特征、漏口的原因和部位、检查方法、颅底结构、治疗选择和治疗结果。
共纳入 15 例（7 例创伤性和 8 例非创伤性）患者。所有病例均进行了影像学检查。最常见的漏口部位是筛板（15 例中有 9 例）。右侧和左侧 Keros 高度的平均值±标准差分别为 4.43±1.66mm 和 4.21±1.76mm。最常见的是 II 型 Keros（60%）。右侧和左侧筛板斜率的平均值±标准差分别为 51.91±13.43 度和 63.54±12.64 度。最常见的是 II 型 Gera 结构（80%）。除 2 例患者外，所有患者均采用经鼻内镜手术修复，成功率为 92.3%。除 1 例患者外，所有患者均采用多层修复技术。术后平均住院时间为 9.07±6.17 天。
非创伤性 CSF 鼻漏多于创伤性 CSF 鼻漏，最常见的漏口部位是筛板。影像学检查在诊断中起重要作用，Gera 分类似乎比 Keros 分类更能评估风险。保守治疗和手术治疗均有效。经鼻内镜 CSF 漏修复是主要的治疗方法。
