Saim L, McKenna M J, Nadol J B
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
Am J Otol. 1996 Mar;17(2):335-9.
Cerebrospinal fluid otorhinorrhea after surgery for cerebellopontine angle tumors may persist despite obliteration of the mastoid, middle ear, and tympanic orifice of the eustachian tube. In this study, histologic sections of 120 adult temporal bones were examined by light microscopy to determine the incidence of peritubal pneumatization and to demonstrate the frequency of tubal and tympanic openings of the peritubal cells. The results of this study suggest that the pathway for these persistent cerebrospinal fluid leaks may be via the peritubal cells that open directly into the eustachian tube anterior to its tympanic orifice. Peritubal pneumatization was present in 78 (65%) of the temporal bones. Of the 57 specimens in which the openings of the peritubal cells could be identified, in 52 (91%), the cells opened into the eustachian tube anterior to its tympanic orifice, and in only five (9%), they opened into the middle ear. The overall incidence of tubal openings in this study was 59%. In 13 temporal bones (21%), the tubal opening were at a distance of > 5 mm anterior to the tympanic orifice of the eustachian tube. Therefore, cerebrospinal leak may persist through these tubal openings despite obliteration of the mastoid, middle ear, and tympanic orifice of the eustachian tube. A case of persistent cerebrospinal fluid leak in which extensive peritubal pneumatization was demonstrated by computed tomography scan is presented. Successful control of the leak was obtained only after the tubal openings of these cells several millimeters anterior to the tympanic orifice were obliterated.
尽管乳突、中耳和咽鼓管鼓口已被封闭，但桥小脑角肿瘤手术后的脑脊液耳鼻漏仍可能持续存在。在本研究中，对120块成人颞骨的组织切片进行了光学显微镜检查，以确定咽鼓管周围气化的发生率，并显示咽鼓管周围细胞通向咽鼓管和鼓室的开口频率。本研究结果表明，这些持续性脑脊液漏的途径可能是通过直接开口于咽鼓管鼓口前方的咽鼓管周围细胞。78块（65%）颞骨存在咽鼓管周围气化。在57块能识别出咽鼓管周围细胞开口的标本中，52块（91%）的细胞开口于咽鼓管鼓口前方的咽鼓管，只有5块（9%）开口于中耳。本研究中咽鼓管开口的总体发生率为59%。在13块颞骨（21%）中，咽鼓管开口位于咽鼓管鼓口前方>5mm处。因此，尽管乳突、中耳和咽鼓管鼓口已被封闭，但脑脊液漏仍可能通过这些咽鼓管开口持续存在。本文报告1例持续性脑脊液漏病例，计算机断层扫描显示存在广泛的咽鼓管周围气化。只有在封闭鼓口前方数毫米处这些细胞的咽鼓管开口后，才成功控制了漏液。
