Yamakami I, Serizawa T, Yamaura A, Nakamura T
Department of Neurosurgery, Chiba University School of Medicine.
No Shinkei Geka. 1996 Jan;24(1):29-33.
We investigated the incidence, prevention and management of postoperative cerebrospinal fluid (CSF) leaks in 64 cranial base surgeries (18 transzygomatic subtemporal approaches, 14 transpetrous approaches, 21 suboccipital approaches and 11 lateral approaches). The incidence was 13% (8/64); the lateral approach had the highest incidence (25%) among the four surgical approaches. The CSF leakage usually occurred as rhinorrhea, but the lateral approach resulted in the subcutaneous CSF retention and CSF leakage from the surgical wound. Six CSF leaks developed within 10 days after surgery ("early onset") and two developed 21 and 23 days after surgery ("late onset"). Preventive lumbar CSF drainage was significantly effective. Post-operative CSF leak occurred in none of 8 cases using preventive lumbar CSF drainage and in 8 out of 56 cases without it (P < 0.01). Lumbar CSF drainage was also effective in the treatment of the postoperative CSF leaks; it cured 5 out of 8 CSF leaks. All of the five CSF leaks which were cured by lumbar drainage were of the "early onset" type. Both of the two "late onset" CSF leaks needed surgical treatment.
我们对64例颅底手术（18例经颧弓颞下入路、14例经岩骨入路、21例枕下入路和11例外侧入路）术后脑脊液漏的发生率、预防及处理进行了研究。发生率为13%（8/64）；外侧入路在四种手术入路中发生率最高（25%）。脑脊液漏通常表现为鼻漏，但外侧入路导致皮下脑脊液潴留及手术切口脑脊液漏。6例脑脊液漏在术后10天内出现（“早发型”），2例分别在术后21天和23天出现（“晚发型”）。预防性腰大池脑脊液引流显著有效。采用预防性腰大池脑脊液引流的8例患者中无一例发生术后脑脊液漏，未采用的56例中有8例发生（P<0.01）。腰大池脑脊液引流对术后脑脊液漏的治疗也有效；8例脑脊液漏中有5例治愈。经腰大池引流治愈的5例脑脊液漏均为“早发型”。2例“晚发型”脑脊液漏均需手术治疗。
