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从耳鼻喉外科和神经外科角度看额底鼻漏的指征与治疗(作者译)

[Indication and treatment of frontobasal rhinoliquorrhoea from the ent-surgical and neurosurgical point of view (author's transl)].

作者信息

Samii M, Draf W

出版信息

Laryngol Rhinol Otol (Stuttg). 1978 Aug;57(8):689-97.

PMID:682787
Abstract

This paper deals with some special questions based on joint neuro-rhinosurgical diagnostic and treatment of frontobasal injuries with rhinoliquorrhoea. The indications of the rhinosurgical transfronto-orbital approach with debridement of paranasal sinuses in the same stage are defined. Detailed technical instructions are given for treatment of "midline fractures". The transfrontal intradural approach of the neurosurgeon should be prefered: 1. If there is rhinoliquorrhoea combined with an extensive fracture of anterior skull base. 2. In cases of frontobasal liquor fistual--no matter of localisation and extension--with increasing spaceoccupation should the intracranial decompression be combined with duraplasty. Cerebral lesions with no progressive intracranial pressure should be treated first of all conservatively. The operative treatment of paranasal sinuses is not necessary in every case after transfrontal intradural surgery. X-ray controls have shown the spontaneous healing.

摘要

本文探讨了基于额鼻联合手术诊断和治疗伴有鼻漏的额底损伤的一些特殊问题。明确了同期行鼻外科经额眶入路并清理鼻窦的适应证。给出了治疗“中线骨折”的详细技术指导。神经外科医生应首选经额硬膜内入路:1. 若存在鼻漏合并广泛的前颅底骨折。2. 对于额底脑脊液瘘——无论其位置和范围如何——伴有占位效应增加时,应将颅内减压与硬脑膜成形术相结合。对于无进行性颅内压升高的脑损伤,首先应采取保守治疗。经额硬膜内手术后,并非每种情况都需要对鼻窦进行手术治疗。X线检查显示可自行愈合。

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