Dodson E E, Gross C W, Swerdloff J L, Gustafson L M
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
Otolaryngol Head Neck Surg. 1994 Nov;111(5):600-5. doi: 10.1177/019459989411100510.
The management of cerebrospinal fluid rhinorrhea has historically plagued the neurosurgeon and the otolaryngologist-head and neck surgeon. Intracranial repair is still favored at many institutions, despite its inherent morbidity. Extracranial nonendoscopic techniques have been previously described but have not gained wide acceptance. More recently, several reports have been published describing a variety of endoscopic techniques in limited patient series used to manage cerebrospinal fluid rhinorrhea. We present our series of 29 patients with cerebrospinal fluid rhinorrhea, treated with endoscopic techniques between December 1989 and June 1993, with follow-up ranging from 3 to 43 months. This represents the largest reported series to date of patients treated with this technique. Our technique has evolved during this time period but centers around the use of free tissue grafts from various donor sites. The causes of the skull base defects in this series included neurosurgical procedures (9), functional endoscopic sinus surgery (8), and trauma (3). Defects occurred spontaneously in 9 cases. The fovea ethmoidalis and sphenoid sinus were the site in 11 and 12 cases, respectively, and the cribriform plate was involved in 6 cases. Cerebrospinal fluid rhinorrhea was documented by nasal endoscopy with or without intrathecal fluorescein, laboratory studies, computed tomography with or without contrast cisternography, and radioisotope cisternography in various combinations. Resolution of cerebrospinal fluid rhinorrhea was achieved in 22 of 29 patients (75.9%) with one endoscopic procedure and 25 of 29 patients (86.2%) after a second attempt. Four patients required neurosurgical intervention for recurrent cerebrospinal fluid rhinorrhea. Complications were minimal and were related primarily to the original pathology or procedure. Cerebrospinal fluid rhinorrhea can be managed safely and effectively with endoscopic techniques in a majority of cases, and the morbidity of open procedures can be avoided.
脑脊液鼻漏的治疗一直以来都困扰着神经外科医生和耳鼻咽喉-头颈外科医生。尽管颅内修复存在固有并发症，但在许多机构中仍受到青睐。此前已有关于颅外非内镜技术的描述，但尚未得到广泛认可。最近，有几篇报道发表，描述了在有限患者系列中用于治疗脑脊液鼻漏的各种内镜技术。我们报告了1989年12月至1993年6月期间采用内镜技术治疗的29例脑脊液鼻漏患者系列，随访时间为3至43个月。这是迄今为止报道的采用该技术治疗患者的最大系列。在此期间，我们的技术不断发展，但主要围绕使用来自不同供体部位的游离组织移植物。该系列中颅底缺损的原因包括神经外科手术（9例）、功能性内镜鼻窦手术（8例）和外伤（3例）。9例缺损为自发性。筛骨水平板和蝶窦分别为11例和12例的病变部位，筛板受累6例。通过鼻内镜检查（有或无鞘内注射荧光素）、实验室检查、有或无对比剂脑池造影的计算机断层扫描以及放射性核素脑池造影等多种组合方式记录脑脊液鼻漏情况。29例患者中有22例（75.9%）经一次内镜手术脑脊液鼻漏得到解决，29例患者中有25例（86.2%）在第二次尝试后得到解决。4例患者因复发性脑脊液鼻漏需要神经外科干预。并发症极少，主要与原发病理或手术有关。在大多数情况下，内镜技术可安全有效地治疗脑脊液鼻漏，且可避免开放手术的并发症。
