Stammberger H, Greistorfer K, Wolf G, Luxenberger W
Klinische Abteilung für Allgemeine HNO.
Laryngorhinootologie. 1997 Oct;76(10):595-607. doi: 10.1055/s-2007-997487.
For more than 25 years, intrathecal 5% sodium fluorescein has been routinely used at the University ENT Hospital at Graz during surgical closures of CSF leaks of the anterior skull base. Especially with endoscopic approaches, this technique has been of significant help in identifying and localizing dural defects. No fluorescein-related complications occurred in the series reported.
In a retrospective study, indications, techniques, and results of surgical closures of CSF leaks of the anterior skull base are reviewed. During 5 1/2 years from 1990-1995, 72 patients with CSF-rhinorrhea were operated on at our department, 69 of whom had sodium fluorescein applied intrathecally. In 41 patients strictly endoscopic techniques were applied, in 22 patients an external approach was chosen and in 9 cases combined approaches were used. Defects in the roof of the ethmoid, the lamina cribrosa, and in the sphenoid sinus almost exclusively were approached endoscopically. Defects in the posterior table of the frontal sinus, especially when located laterally, were approached from externally or via combined endonasal and external routes. The causes of the CSF leaks, their localization, and the surgical approaches chosen are analysed and the surgical techniques described in detail.
The direct coronal CT of the paranasal sinuses/anterior skull base proved to be significantly better in detecting lesions compared to axial CT images (82% vs. 53%). In all cases intrathecal fluorescein allowed for a precise localization of the defect(s). There were no fluorescein related complications in this series. In one patient with massive frontobasal chip fractures and substantial dural defect, a rhinosurgical closure was not successful. Two patients developed recurrent fistulae after several months and years respectively. One of these patients had to be operated 3 times until permanent closure was achieved. Two patients had to be revised because of mucoceles of the frontal sinuses, in both cases the initial closure of the dural defect proved to be tight.
Our results demonstrate that with exception of defects of the posterior lateral table of the frontal sinus, CSF leaks of the rhinobasis can be closed safely endoscopically. After a follow-up from 19-65 months, the overall success rate for 72 CSF leaks was at 94.5%. When applied correctly, the fluorescein technique proves to be an extremely helpful technique for diagnosis and surgery of CSF leaks.
25多年来，格拉茨大学耳鼻喉医院在前颅底脑脊液漏手术修补时常规使用鞘内注射5%的荧光素钠。尤其是在内镜手术中，该技术在识别和定位硬脑膜缺损方面有很大帮助。在已报道的病例系列中未发生与荧光素相关的并发症。
回顾性研究前颅底脑脊液漏手术修补的适应证、技术及结果。1990年至1995年的5年半时间里，我科对72例脑脊液鼻漏患者进行了手术，其中69例接受了鞘内注射荧光素钠。41例严格采用内镜技术，22例选择外部入路，9例采用联合入路。筛骨顶、筛板及蝶窦内的缺损几乎均采用内镜处理。额窦后壁的缺损，尤其是位于外侧时，采用外部入路或经鼻内和外部联合入路。分析脑脊液漏的病因、部位及所选择的手术入路，并详细描述手术技术。
鼻窦/前颅底的直接冠状位CT在检测病变方面明显优于轴位CT图像（82%对53%）。在所有病例中，鞘内注射荧光素可精确确定缺损部位。本系列中未发生与荧光素相关的并发症。1例额底大块骨折并存在较大硬脑膜缺损的患者，鼻内手术修补未成功。2例患者分别在数月和数年后出现复发性瘘管。其中1例患者需手术3次才实现永久性闭合。2例患者因额窦黏液囊肿需再次手术，2例患者最初的硬脑膜缺损修补均证实牢固。
我们的结果表明，除额窦后外侧壁缺损外，鼻源性脑脊液漏可通过内镜安全修补。经过19至65个月的随访，72例脑脊液漏的总体成功率为94.5%。荧光素技术应用正确时，对脑脊液漏的诊断和手术是一项极有帮助的技术。
