Vinciguerra Alessandro, Dohin Isabelle, Daloiso Antonio, Boaria Francesco, Marc Morgane, Verillaud Benjamin, Chatelet Florian, Herman Philippe
Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, 75010 Paris, France.
Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy.
J Pers Med. 2024 Feb 21;14(3):226. doi: 10.3390/jpm14030226.
Iatrogenic cerebrospinal fluid leak (iCSF-L) is a major complication of endonasal surgeries whose occurrence is always a potential adverse event due to anatomical variation/asymmetry of the skull base (SB). The aim of this manuscript is to provide a topographical map of iCSF-L and to investigate the role of SB asymmetry in iCSF-L occurrence.
In this retrospective study, the location of iCSF-L dural defect was studied and compared to patients affected by spontaneous and post-traumatic CSF-L. Considering only iCSF-L, after having collected the SB asymmetry data, the Keros, Gera, distance of the anterior ethmoidal artery from the SB, frontal sinus pneumatization, and Thailand-Malaysia-Singapore score classifications were compared to a control group of patients.
A total of 153 CSF-Ls (103 spontaneous, 37 iatrogenic, and 13 traumatic) were included. A significant association was noted ( < 0.001) between the nature of the CSF-L and the areas involved. Considering iCSF-Ls, only the Gera classification was significantly different ( < 0.05) and the most reliable in predicting the risk of dural transgression (AUC = 0.719).
ICSF-Ls present peculiar regional SB involvement with the cribriform plate, with the ethmoidal roof being the most involved. After having assessed the asymmetry of the SB, the Gera classification was the most reliable one.
医源性脑脊液漏（iCSF-L）是鼻内手术的主要并发症，由于颅底（SB）的解剖变异/不对称，其发生始终是一种潜在的不良事件。本手稿的目的是提供iCSF-L的地形图，并研究SB不对称在iCSF-L发生中的作用。
在这项回顾性研究中，对iCSF-L硬脑膜缺损的位置进行了研究，并与自发性和创伤后脑脊液漏患者进行了比较。仅考虑iCSF-L，在收集SB不对称数据后，将Keros、Gera、筛前动脉距SB的距离、额窦气化和泰国-马来西亚-新加坡评分分类与对照组患者进行比较。
共纳入153例脑脊液漏（103例自发性、37例医源性和13例创伤性）。脑脊液漏的性质与受累区域之间存在显著关联（<0.001）。考虑到iCSF-L，只有Gera分类有显著差异（<0.05），并且在预测硬脑膜侵犯风险方面最可靠（AUC = 0.719）。
iCSF-L在筛板处有特殊的颅底区域受累，筛窦顶部受累最为严重。在评估颅底不对称后，Gera分类是最可靠的。
