Choi D, Spann R
University Department of Surgery, Royal Infirmary, Glasgow, UK.
Br J Neurosurg. 1996 Dec;10(6):571-5. doi: 10.1080/02688699646880.
Cerebrospinal fluid (CSF) leakage following head trauma is often difficult to diagnose, but is of considerable importance in view of the possibility of fistula formation and meningitis. It is unclear whether specific clinical or radiological signs point to an increased risk of CSF leakage. Previous studies have been largely anecdotal and uncontrolled, leading us to perform a retrospective control study comparing the clinical and radiological features of patients with overt CSF leakage, and those without. Of the 293 patients studied, 115 had clinical CSF leakage and 170 did not, with incomplete documentation in eight patients. The group with CSF rhinorrhoea had significantly greater incidence of periorbital haematoma (chi square = 8.642). This suggests that patients with head injuries and features of periorbital haematoma are at greater risk of unobserved dural tear and delayed CSF leakage. Frontal and ethmoid fractures in particular were also associated with CSF leakage (chi square = 5.46). The use of prophylactic antibiotics was studied. There was a significantly greater incidence of meningitis in the group which received prophylactic antibiotics (p = 0.024). There was no significant difference in the incidence of meningitis in those patients with CSF fistulae treated by surgical or conservative methods.
头部外伤后脑脊液（CSF）漏常常难以诊断，但鉴于存在形成瘘管和脑膜炎的可能性，其具有相当重要的意义。目前尚不清楚是否有特定的临床或影像学征象提示脑脊液漏的风险增加。以往的研究大多是 anecdotal 且无对照的，这促使我们进行一项回顾性对照研究，比较有明显脑脊液漏患者与无脑脊液漏患者的临床和影像学特征。在研究的293例患者中，115例有临床脑脊液漏，170例无脑脊液漏，8例记录不完整。脑脊液鼻漏组眶周血肿的发生率显著更高（卡方 = 8.642）。这表明有头部损伤且伴有眶周血肿特征的患者发生未被察觉的硬膜撕裂和延迟性脑脊液漏的风险更高。特别是额骨和筛骨骨折也与脑脊液漏相关（卡方 = 5.46）。对预防性使用抗生素进行了研究。接受预防性抗生素治疗的组中脑膜炎的发生率显著更高（p = 0.024）。采用手术或保守方法治疗的脑脊液瘘患者中脑膜炎的发生率没有显著差异。
