Yadav Ramraj, Chaudhary Ashvanee Kumar, Gupta Deepak Kumar, Saroj Sanjay Kumar, Singh Vishwambhar, Kumar Rajesh
Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India.
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Patna, Bihar India.
Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5618-5622. doi: 10.1007/s12070-024-05046-3. Epub 2024 Sep 17.
CSF rhinorrhea secondary to anterior skull base defect may be spontaneous or traumatic (accidental or iatrogenic), spontaneous being common in middle aged, obese females. Nowadays endoscopic technique is gold standard for anterior skull base defect repair. The graft materials available may be autologous (fat, temporalis fascia, fascia lata, septal mucosa, cartilage, middle turbinate), homologous e.g., cadaveric pericardium or allograft e.g. dural substitute. Leukocyte-platelet rich fibrin (L-PRF) is a newer graft material that contain concentrated platelets and doesn't require any exogenous material or chemical in blood. A prospective study including 31 patients was carried out at tertiary care centre in eastern India, over the period of 2 years. All the surgeries targeted for closure of the anterior skull base defect were performed endoscopically under general anaesthesia. 30 out of 31 (96.77%) patients successfully improved after repair and one patient required revision surgery due to recurrence of disease and was cured after revision surgery. Autologous Leokocyte-plasma rich fibrin (L-PRF) is a newer and cost-effective graft material for the CSF leak repair with good healing property and with a success rate of more than 95%.
继发于前颅底缺损的脑脊液鼻漏可能是自发性的或创伤性的(意外或医源性),自发性脑脊液鼻漏在中年肥胖女性中较为常见。如今,内镜技术是修复前颅底缺损的金标准。可用的移植材料可能是自体的(脂肪、颞肌筋膜、阔筋膜、鼻中隔黏膜、软骨、中鼻甲)、同种异体的(如尸体心包)或异种移植物(如硬脑膜替代物)。富含白细胞-血小板的纤维蛋白(L-PRF)是一种新型移植材料,含有浓缩血小板,且不需要血液中的任何外源物质或化学物质。在印度东部的一家三级医疗中心进行了一项为期2年的前瞻性研究,纳入31例患者。所有针对前颅底缺损闭合的手术均在全身麻醉下通过内镜进行。31例患者中有30例(96.77%)在修复后成功改善,1例患者因疾病复发需要再次手术,再次手术后治愈。自体富含白细胞-血浆的纤维蛋白(L-PRF)是一种新型且具有成本效益的用于脑脊液漏修复的移植材料,具有良好的愈合特性,成功率超过95%。