Tang Ru, Zhang Shi-Yao, Zhou Jia-Yao, Gu Yue-Long, Mao Song, Zhang Wei-Tian
Department of Otolaryngology Head and Neck Surgery Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China.
World J Otorhinolaryngol Head Neck Surg. 2025 Feb 20;11(3):391-399. doi: 10.1002/wjo2.70000. eCollection 2025 Sep.
The aim of this study is to compare the clinical characteristics and surgical outcomes of patients with traumatic and nontraumatic cerebrospinal fluid (CSF) rhinorrhea.
CSF rhinorrhea patients admitted between January 2007 and December 2022 were recruited and categorized into traumatic and nontraumatic groups. The clinical characteristics and surgical outcomes of the two groups were compared.
A total of 94 patients with traumatic and 49 patients with nontraumatic CSF rhinorrhea were included. The prevalence of meningitis was significantly higher in traumatic CSF rhinorrhea patients ( = 0.012). Multifocal defects were more frequent in the traumatic group, while sphenoidal defects were significantly correlated with nontraumatic CSF rhinorrhea. Frontal defects were commonly identified in CSF rhinorrhea patients with meningitis than in those without, though no statistical significance was reported. Multivariate logistic regression revealed that male sex, iatrogenic traumatic CSF leak, and pneumonitis are independent factors for development of meningitis. An endoscopic approach combined with an external incision was performed in one patient and 24 patients in nontraumatic and traumatic groups, respectively ( = 0.001). Combined vascularized grafts were more commonly used in patients with traumatic CSF rhinorrhea ( < 0.05). No statistical difference in the success rate (100% vs. 97.9%) was documented between the two groups.
Multifocal defects and meningitis were more prevalent in traumatic CSF rhinorrhea patients, leading to increased complexity in treatment management. Iatrogenic rather than accidental traumatic CSF rhinorrhea is an independent risk factor for development of meningitis. The endoscopic combined coronal extradural approach, in conjunction with various vascularized flaps, can effectively supplement skull base reconstruction, especially for complex traumatic CSF rhinorrhea.
本研究旨在比较创伤性和非创伤性脑脊液鼻漏患者的临床特征及手术效果。
纳入2007年1月至2022年12月收治的脑脊液鼻漏患者，分为创伤性和非创伤性两组，比较两组的临床特征及手术效果。
共纳入94例创伤性脑脊液鼻漏患者和49例非创伤性脑脊液鼻漏患者。创伤性脑脊液鼻漏患者脑膜炎的患病率显著更高（P = 0.012）。多灶性缺损在创伤组更常见，而蝶窦缺损与非创伤性脑脊液鼻漏显著相关。脑脊液鼻漏合并脑膜炎的患者中额叶缺损比未合并脑膜炎的患者更常见，尽管未报告统计学意义。多因素logistic回归显示，男性、医源性创伤性脑脊液漏和肺炎是脑膜炎发生的独立因素。非创伤性组和创伤性组分别有1例和24例患者采用内镜联合外部切口的方法（P = 0.001）。带血管蒂移植物更常用于创伤性脑脊液鼻漏患者（P < 0.05）。两组成功率（100%对97.9%）无统计学差异。
多灶性缺损和脑膜炎在创伤性脑脊液鼻漏患者中更普遍，导致治疗管理的复杂性增加。医源性而非意外创伤性脑脊液鼻漏是脑膜炎发生的独立危险因素。内镜联合冠状硬膜外入路，结合各种带血管蒂皮瓣，可有效补充颅底重建，尤其是对于复杂的创伤性脑脊液鼻漏。
