Nutik S L, Korol H W
Department of Neurosurgery, Kaiser-Permanente Medical Center, Redwood City, California 94063, USA.
Surg Neurol. 1995 Jun;43(6):553-6; discussion 556-7. doi: 10.1016/0090-3019(95)00016-x.
CSF rhinorrhea is a common complication of acoustic neuroma surgery.
Twenty cases of persistent cerebrospinal fluid rhinorrhea, 2 of transient leaks, and 2 of late meningitis occurring in a series of 156 posterior fossa acoustic neuroma removals were studied. Prophylaxis of leaks was usually attempted by filling opened air cells in the drilled internal auditory canal (IAC) with bone wax. Communications were repaired by rewaxing the IAC, or by fat packing of either the mastoid or the eustachian tube, middle ear, and mastoid.
Most leaks were diagnosed within 1 week of surgery, although 1 occurred 4 years postoperatively. Those seen later were usually recurrences of a previously repaired leak or cases of meningitis. Leaks were more common later in the series when a more lateral unroofing of the IAC was used. The communication usually occurred through air cells opened while unroofing the canal, but two were via the vestibule and oval window. Treatment failed in 38% of cases in which canal rewaxing was used. There were no failures when the communication was sealed by fat obliteration of the eustachian tube, middle ear, and mastoid.
Leaks are more common with a more lateral unroofing of the IAC. A leak may occur into the middle ear via the oval window. Optimal treatment is packing of the middle ear and mastoid with fat.
脑脊液鼻漏是听神经瘤手术的常见并发症。
对156例后颅窝听神经瘤切除术中出现的20例持续性脑脊液鼻漏、2例短暂性漏液及2例迟发性脑膜炎病例进行了研究。预防漏液通常是通过用骨蜡填充磨开的内耳道（IAC）中的开放气房来实现。通过对内耳道重新填蜡，或通过用脂肪填充乳突或咽鼓管、中耳和乳突来修复交通支。
大多数漏液在术后1周内被诊断出来，尽管有1例在术后4年出现。较晚出现的通常是先前修复的漏液复发或脑膜炎病例。当采用更外侧的内耳道开放术时，系列病例中漏液更常见。交通支通常通过在开放内耳道时打开的气房形成，但有两例是通过前庭和卵圆窗形成。在使用内耳道重新填蜡的病例中，38%的治疗失败。当通过用脂肪闭塞咽鼓管、中耳和乳突来封闭交通支时，没有出现失败情况。
采用更外侧的内耳道开放术时漏液更常见。漏液可能通过卵圆窗进入中耳。最佳治疗方法是用脂肪填充中耳和乳突。
