Simmen D, Bischoff T
Klinik für Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitätsspital Zürich.
Laryngorhinootologie. 1998 May;77(5):264-71. doi: 10.1055/s-2007-996972.
Cerebrospinal fluid (CSF) leak, with its potential infectious complications remains today a challenge in diagnosis and surgical treatment. With the introduction of endonasal microsurgery, new minimally invasive techniques for the repair of these defects have been pioneered. Nasal approaches to the anterior skull base include external-transfacial as well as endonasal approaches for reconstruction. It is important to have multiple possible approaches for the correction so that the optimal method for the individual pathology may be selected. The purpose of this paper is to clarify the decision process for selecting the safest procedure with the least possible morbidity and functional compromise.
In a retrospective study we assessed a group of 69 patients treated from 1988 to 1996. Patient records, CT scans, postoperative clinical follow-up and a questionnaire, sent to the patients, were evaluated. The various external and endonasal approaches are presented and the closure techniques are discussed in detail.
Of the 69 operations, 40 (58%) were external and 29 (42%) were endonasal. There were three failures in the external approach group (4.4%) and no failures in the endonasal group. No major complications in the intraoperative or postoperative course occurred. Of importance, olfaction was retained in 94% of patients in at least one side. The average duration of hospitalization was 6 days.
Nasal approaches to the anterior skull base for treatment of CSF leaks are highly effective, safe, and cause minimal morbidity. The optimal surgical approach is chosen according to the precise location and extent of the defect. We are now increasing using endonasal microsurgical approaches. The open, transfacial approaches are still indicated for fractures of the posterior wall of the frontal sinus as well as larger multi-fragmented fractures of the anterior skull base.
脑脊液漏及其潜在的感染并发症在当今仍是诊断和外科治疗中的一项挑战。随着鼻内镜显微手术的引入，开创了修复这些缺损的新型微创技术。经鼻入路至前颅底包括用于重建的外经面部入路以及鼻内镜入路。拥有多种可能的矫正方法很重要，以便能为个体病变选择最佳方法。本文的目的是阐明选择最安全、发病率和功能损害最小的手术方法的决策过程。
在一项回顾性研究中，我们评估了1988年至1996年期间接受治疗的69例患者。对患者记录、CT扫描、术后临床随访以及发给患者的一份问卷进行了评估。介绍了各种外经面部和鼻内镜入路，并详细讨论了封闭技术。
在69例手术中，40例（58%）为外经面部手术，29例（42%）为鼻内镜手术。外经面部手术组有3例失败（4.4%），鼻内镜手术组无失败病例。术中或术后过程中未发生重大并发症。重要的是，94%的患者至少一侧嗅觉得以保留。平均住院时间为6天。
经鼻入路至前颅底治疗脑脊液漏高效、安全，且发病率极低。根据缺损的确切位置和范围选择最佳手术入路。我们现在越来越多地使用鼻内镜显微手术入路。开放的、经面部入路仍适用于额窦后壁骨折以及前颅底较大的多碎片骨折。
