自发性脑脊液耳漏的临床分析

目的 总结归纳并探讨自发性脑脊液耳漏(SCSFO)的临床特点、手术方式及术后疗效。方法 回顾性分析 2015—2020年收治的SCSFO患者的临床资料，总结病例的临床特点，分析归纳病例的漏口、手术修补方式、术后反应，并随访手术效果。结果 共收集10例SCSFO病例资料，其中男4例，女6例；儿童患者3例，成人患者7例。病史25 d至20余年，单侧发病9例，双侧发病1例。3例儿童患者均为先天性极重度感音神经性耳聋，均因发现鼻漏或脑膜炎就诊。7例成人患者中，因耳闷伴听力下降就诊5例，其中1例同时合并耳漏；因鼻漏就诊1例；因耳痛合并脑膜炎就诊1例。外院曾行鼓膜穿刺或置管史4例。3例儿童患者中，缺损部位均位于镫骨足板处和镫骨周围，其中2例患者伴镫骨畸形；7例成人患者中，2例漏口位于镫骨足板，3例漏口位于鼓室天盖，2例漏口位于乳突天盖。1例术后出现癫痫及颅内压升高。10例患者随访周期为5个月至 6年，均无再发脑脊液耳漏。结论 早期识别脑脊液耳漏的不典型症状，掌握确诊脑脊液耳漏的定位、定性诊断方法非常重要。SCSFO保守治疗效果差，一旦确诊，建议积极手术探查，精准寻找漏点，确切修补漏口是关键。

Clinical analysis of spontaneous cerebrospinal fluid otorrhea

Objective To analyze and explore the clinical characteristics, surgical methods and postoperative effect of spontaneous cerebrospinal fluid otorrhea (SCSFO).Methods Clinical data of 10 patients with SCSFO admitted to our department from 2015 to 2020 were retrospectively analyzed, and the clinical characteristics, imaging features, surgical methods, perioperative management, and postoperative follow-up results were summarized.Results Of all the cases, 6 were female and 4 male including 3 children and 7 adults. The disease history ranged from 25 days to more than 20 years. Nine cases were unilateral and one was bilateral. All the 3 children suffered from congenital severe sensorineural hearing loss, and were diagnosed with rhinorrhea or meningitis. Among the 7 adults, 5 cases suffered from ear fullness and hearing loss with accompanied otorrhea in one, one suffered from rhinorrhea and another one suffered from ear pain accompanied with meningitis. Four patients had past history of tympanocentesis or myringotomy with grommet insertion. The leak points were located at and around the stapedial foot plate in all the 3 children (4 ears) with stapes deformity in 2. Of the 7 adults, the leaks points were located at the stapedial foot plate in 2, tympanic tegmentum in 3 and mastoid tegmentum in 2. Postoperative epilepsy and increased intracranial pressure occurred in one case. All the patients were followed up for 5 months to 6 years, and there was no recurrence of cerebrospinal fluid otorrhea.Conclusions It is particularly important to identify the early symptoms, master the localization and qualitative diagnosis methods of SCSFO. Once diagnosed, surgical exploration is recommended due to poor conservative treatment outcome. Accurate localization of leak point and exact repair of leaks are essential.