以脑脊液鼻漏为表现的蝶窦神经胶质瘤

1 临床资料 患者,男,66岁,因左侧鼻腔流清水样涕7个月余入院.患者自诉7个月前无明显诱因左侧鼻腔流清水样涕,伴阵发性头痛,头痛呈刺痛,位于双侧颞部,低头时明显;无鼻塞、流脓涕,无鼻腔出血,无视力下降或眼球活动障碍,无恶寒、发热,无头晕等.在当地医院住院后给予抗炎静滴治疗及口服药物治疗,疗效欠佳;转上级医院进一步检查后以脑脊液鼻漏来我院收住院.专科检查:鼻腔黏膜稍充血,鼻中隔向左偏曲,低头前倾时左侧鼻腔可见清亮液体流出.     

经鼻内镜及影像导航系统行脑脊液鼻漏修补1例

病人,男,49岁,因右侧鼻腔流清水样物3个月,于2006年2月20日入院。3个月前,病人无明显诱因出现右侧鼻腔流出无色无嗅清水样物,无发热、头痛、颈项强直及喷射性呕吐,无手术外伤史,无鼻痒、喷嚏、鼻塞等症状。外院以变应性鼻炎予以治疗,症状无缓解。此后,清水样物流出渐增多,低头时明显,右眼视力下降,偶有头痛、头闷胀感。入院查体:外鼻无畸形,双下鼻甲较大,鼻中隔明显右偏,右侧鼻腔狭窄,有水样分泌物流出。外院CT扫描示:右侧蝶窦、双侧筛窦内可见黏膜增厚,窦壁骨质连续,鼻中隔偏曲。外院MRI示:蝶窦内见明显长T1、长T2信号影,向周围波及右侧…     

鼻咽异位垂体腺瘤1例

患者,女,17岁,因双侧鼻塞伴右侧流涕6年于2009年8月4日入院.患者6年来双侧持续性鼻塞,右侧较重,伴右侧流涕,涕白色、黏稠,无臭味,无鼻出血及涕中带血,无头晕头痛.体检:鼻中隔右偏明显,右鼻腔狭窄,收缩后鼻内镜下见右后鼻孔为肿物所堵塞,肿物表面黏膜光滑呈灰白色.间接鼻咽镜下见右侧鼻咽类圆形肿物坠入右侧后鼻孔.CT示:右侧鼻咽部结节状软组织影,基底部与右侧咽壁分界不清.     

经鼻内窥镜治愈自发性脑脊液鼻漏2例

例 1　女 ,5 2岁。右鼻流“清涕”2个月入院。 2个月前不明原因右鼻流“清涕” ,低头、用力时增多 ,偶鼻痒 (蚁行感 ) ,无鼻阻、喷嚏。外院诊断变应性鼻炎。经脱敏治疗无效。体检 :患者低头抱膝时 ,透明液体自前鼻孔点滴样流出 ,1 8～ 2 2滴 /ｍｉｎ。1 %地卡因加肾上腺素充分收缩麻醉下 ,鼻内窥镜检查见右中鼻道中后 1 /3处 ,中鼻甲根部有一约0 .3ｃｍ× 0 .9ｃｍ粘膜苍白区 ,压迫同侧颈静脉 ,再嘱患者用力 ,镜下见透明液体搏动涌出。ＣＴ检查 :右筛窦炎 ,ＣＴ值 6Ｈｕ。漏出液实验室检查 :糖 4.1ｍｍｏｌ/Ｌ ,蛋白 0 .44ｇ/Ｌ ,氯 1 2 1ｍ…     

双侧额窦前颅窝巨大囊肿手术切除1例

患者,男,50岁。因反复发作性鼻流清涕、鼻塞喷嚏3年余就诊。1年前行上颌窦及鼻腔手术,术后右侧鼻腔粘连。2004年3月行微波治疗双鼻甲,术后症状消失,1个月后复发。同年4月再次微波治疗无效。近来加重于同年7月22日来我院就诊治疗。检查:右鼻腔粘连性闭锁,左鼻腔黏膜高度水肿,苍白、渗液。CT检查:左额窦后壁有4.0cm×3.5cm吸收区,阴影内入脑实质4.5cm。右侧额窦占位性病变,右额窦后壁1.0cm×0.8cm骨质缺损,无压迫大脑痕迹。MRI:双侧额窦内可见长T1、T2异常信号,左异常信号3.0cm×4.5cm×2.0cm,双侧筛窦及蝶窦内可见液体信号影,左上颌窦黏膜…     

鼻内镜术并发眶内巨大气肿1例

患者 ,男 ,47岁。因进行性双侧鼻阻塞伴流黏稠涕 5年于 2 0 0 2年 1 1月 2日入院。入院诊断“慢性鼻窦炎 ;鼻息肉 ,Ⅱ型Ⅲ期”。鼻内镜检查 :双侧鼻腔黏膜呈慢性充血状 ,鼻中隔居中 ,双侧下鼻甲形态正常 ,中鼻道内可见荔枝肉样新生物生长 ,总鼻道内可见脓性分泌物。鼻窦CT冠状位示 :双侧前中组筛窦、上颌窦黏膜增厚 ,窦腔缩小 ,双侧鼻腔可见软组织密度增高影。入院后行各项常规辅助检查未见异常。于局麻下行鼻内镜下双侧筛窦、上颌窦开放 ,息肉摘除术。手术采取Messerklinger术式 ,切除双侧钩突 ,开放双侧前中组筛窦 ,见双前中组筛窦内黏…     

鼻腔嗜酸性细胞乳头状瘤1例

患者,女,47岁,因反复鼻塞、流涕10余年,加重伴鼻根胀痛、头昏1个月余于2011年4月18日入院。患者流清涕,无鼻出血、流脓涕,无嗅觉减退、面部麻木,无耳鸣、流泪等。专科检查:双侧下鼻甲肥厚,鼻道内少许黏性分泌物,鼻中隔右偏。鼻窦CT:双侧上颌窦、右侧部分筛窦和右额窦慢性炎症,鼻中隔偏曲,右侧中鼻道可见软组织密度影     

鼻内镜下脑膜膨出脑脊液鼻漏修补1例

1 临床资料 患者,男,33岁。因反复流清水样涕9年余入院。其于9年前不慎将农用钢叉由右鼻刺入颅内,当即昏迷。经当地县医院抢救病情平稳后,右鼻大量清水样涕,经保守治疗后右鼻清涕少量或稍感湿润。此后反复于"感冒"时出现头痛,抽搐,意识模糊,右鼻大量流清水样涕。取右鼻分泌物生化检验确定为脑脊液。查体:右侧中鼻甲于中间分为前后两段,间隙中有清亮液体。MRI检查右侧筛窦致右侧大脑皮质贯通伤,筛骨水平板有直径约2.0 cm的缺损,脑脊     

侵袭性双侧鼻腔鼻窦眶周广泛性感染1例

鼻腔和鼻窦感染性疾病是耳鼻咽喉科常见的多发病,但双侧鼻腔和鼻窦化脓性炎症伴随眶周蜂窝组织炎呈侵袭性发展,并在1月内由局部炎症快速发展为广泛性组织坏死性感染,在临床比较少见,本文报告1例。1临床资料患者女姓,59岁,因右侧鼻塞9天,加重伴右颜面肿胀3天,于20040518日就诊。患者9天前无明显诱因,出现右鼻间歇性阻塞,伴流清涕等感冒症状,服用“罗红霉素”上述症状无好转且出现右侧鼻腔疼痛,无流脓涕。副鼻窦CT显示双侧上颌窦和筛窦及蝶窦腔内软组织影充填,考虑炎症给予抗感染治疗,上述症状仍无好转。3天前感右鼻疼痛加重,且伴右侧面部胀…     

以鼻塞为首发症状的Wegener肉芽肿一例

患者女，39岁。因双侧鼻塞伴头部沉重8个月余，于2006年4月来我院诊治。2000年2月始，患者反复发作性发热，38℃以上1个月左右，伴鼻黄色涕，双侧鼻塞，口服感冒胶囊、感冒通等药物治疗。冬季反复发作性双侧鼻塞，流清水样涕，无连续性喷嚏。2005年6月，当平卧位休息时，由后鼻孔部落入口腔一硬性块状物，     

经鼻蝶垂体瘤切除术后脑脊液鼻漏的影响因素分析

目的探讨经鼻蝶入路垂体腺瘤切除术后发生脑脊液鼻漏的影响因素。方法回顾性分析129例垂体瘤患者经鼻蝶入路垂体瘤切除术的临床资料，判断术后发生脑脊液鼻漏的相关因素。结果术后发生脑脊液鼻漏9例。统计学分析显示，再次手术、术中脑脊液鼻漏及术者经验与术后脑脊液鼻漏的发生呈正相关（P〈0．05）。结论再次手术、术中脑脊液鼻漏和术者经验可能使发生术后脑脊液鼻漏的风险增加。     

Empty sella syndrome, diagnosed as allergic rhinitis.

Unilateral cerebrospinal fluid (CSF) rhinorrhea as the only manifestation of the primary empty sella syndrome is a rare event. A case of a middle-aged male patient complaining for intermittent unilateral rhinorrhea, which started 5 months earlier, is reported. The persistence of this state was attributed to an allergic rhinitis. The initial work-up excluded the above diagnosis and an erroneous radiological diagnosis led to a puncture of the left maxillary sinus. A lateral X-ray of the skull and CT scan led to the diagnosis of empty sella syndrome, possibly due to an adenoma or a meningocele.     

自发性脑脊液鼻漏临床分析

目的探讨自发性脑脊液鼻漏的诊治方法。方法回顾性分析13例自发性脑脊液鼻漏的临床特征、影像学特点及诊治方法与疗效。结果13例自发性脑脊液鼻漏患者,通过询问病史,收集鼻漏出液行葡萄糖定性定量检测,鼻内镜检查和CT、MRI影像学检查均得以确诊,保守治疗无效,均行鼻内镜下修补术,术后随访6个月～6年,均无复发,无脑膜炎等并发症,手术修补成功率100％。结论葡萄糖定性定量检测、鼻内镜检查及CT、MRI影像学检查是诊断自发性脑脊液鼻漏的主要方法,鼻内镜下寻找漏口及修补术具有微创、并发症少及成功率高等优点,是自发性脑脊液鼻漏的首选治疗方法。     

Complications of interstitial radioactive iodine implants for recurrent pituitary adenomas.

Three cases of recurrent pituitary adenoma elected to be treated with I125 implants are presented. The I125 implants caused significant delayed changes in the tissues surrounding the sella turcica which lead to the development of refractory cerebrospinal fluid (CSF) rhinorrhea. All three cases developed meningitis and two had pneumocephalus. This complication lead to the death of two patients and required intensive therapy in the third to achieve recovery.     

Non-traumatic cerebrospinal fluid rhinorrhea

Non-traumatic cerebrospinal fluid rhinorrhea is uncommon. Review of the literature revealed that 45% of cases are high pressure leaks and 55% of cases are normal pressure leaks. Meningoencephaloceles are very rare occurrences in the latter category and we present the third reported case occurring in the frontal sinus. Radiographically this lesion appeared as a mucocele because of its expansile nature, however non-traumatic mucoceles have not been associated with cerebrospinal fluid rhinorrhea. The only non-osseous expansile lesion of the paranasal sinuses found to be associated with this complication is the meningioencephalocele.     

带蒂骨膜瓣修补外伤性脑脊液鼻漏

目的：探讨一种有效的外伤性脑脊液鼻漏修补方法。方法：分析本科收治的6例经颅修补的脑脊液鼻漏，采用带蒂骨膜瓣翻转缝合及EC胶严密封闭漏口。结果：无手术死亡，术后脑脊液漏均停止。通过4个月-2年随访，仅有1例术后3个月轻微复发，保守治疗自愈。结论：该方法取材方便，抗感染能力强，一次手术成功率高。尤其适应于额窦后壁、筛窦顶部骨折或缺损所致的脑脊液鼻漏。     

Cerebrospinal fluid leak following acoustic neuroma removal

Cerebrospinal fluid (CSF) leak has been a constant and unresolved complication of acoustic tumor surgery. This study retrospectively reviews 381 primary acoustic tumor surgeries performed by a single, senior, neurotologist and neurosurgeon team from 1979 through 1991. There were 68 cerebrospinal fluid leaks in 66 patients (66/381; 17%). There was no significant difference in the incidence of CSF leak between the translabyrinthine group (21%) and the retrosigmoid transmeatal group (16%). Translabyrinthine leaks were evenly divided between rhinorrhea and the postauricular wound while retrosigmoid transmeatal leaks were predominantly rhinorrhea. Eleven of 14 translabyrinthine wound leaks responded to pressure dressing and suture. The remaining 3 ceased with continuous lumbar cerebrospinal fluid drainage. Ten of 14 cases of translabyrinthine rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with revision of the mastoidectomy/labyrinthectomy cavity. Twenty-one of 28 cases of retrosigmoid transmeatal rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with extracranial, transmastoid revision. The incidence of cerebrospinal fluid leak was not influenced by age, sex, size of tumor, postoperative hydrocephalus, or the intraoperative use of autologous fibrin glue. Meningitis was an unusual complication, occurring in 3% of all patients.     

鼻内镜修补脑脊液鼻漏的临床分析

目的：探讨鼻内镜下修补脑脊液鼻漏的注意事项、修补材料的选择和并发症的处理。方法：对15例脑脊液鼻漏患者，根据术前确定的漏口部位选择不同的手术径路；根据漏口的大小选择不同的材料进行修补。结果：15例患者均在鼻内镜下修补成功，其中3例因脑脊液鼻漏在不同部位再发，行3次以上手术修补，修补次数最多达5次，1次修补成功率为85．6％。结论：脑脊液鼻漏经鼻内镜修补是一种极好的方法，具有方便、成功率高、并发症少、可重复多次修补等优点，值得推广。     

鼻内镜下修补垂体瘤术后迟发性脑脊液鼻漏

目的 总结经蝶窦入路垂体瘤术后并发迟发性脑脊液鼻漏的原因,探讨鼻内镜下经蝶窦人路脑脊液鼻漏的修补方法.方法 回顾性分析11例经蝶窦入路垂体瘤术后并发迟发性脑脊液鼻漏患者临床资料,分析术后并发脑脊液鼻漏的原因、部位和鼻内镜手术修补情况.结果 11例患者中,7例予自体脂肪、肌肉、游离中鼻甲黏膜瓣分别修补成功;4例予自体肌肉...     

Endoscopic repair of cerebrospinal fluid rhinorrhea — Manipal experience

Otolaryngologists play a major role in the management of cerebrospinal fluid (CSF) rhinorrhea. A thorough understanding of the underlying pathophysiology and the various treatment options available is essential to achieve the best possible results. In this paper, we are highlighting the pathophysiology, diagnosis and surgical technique involved in the repair of cerebrospinal fluid rhinorrhea. A retrospective study conducted in the department of ENT and Head and Neck Surgery, Kasturba Hospital, Manipal is presented to highlight our experience with cerebrospinal fluid rhinorrhea. Eleven patients were managed in the department of otolaryngology between 1999 and 2005. Seven had spontaneous CSF rhinorrhea, three were due to trauma and one iatrogenic, following surgery. Commonest anatomic site of leak was the cribriform plate in 4 cases. Other sites included sphenoid [2], lateral lamella [2], fovea ethmoidalis [2] and olfactory groove [1]. Onlay technique was performed in 10 out of 11 patients. Closure was successful in 10 out of 11 cases in the first attempt. One patient underwent revision surgery. Patients were followed up for a period ranging from 3 months to 3 years. CSF rhinorrhea is a potentially fatal condition which requires precise and urgent treatment. The transnasal endoscopic repair of CSF leak has a high success rate with low morbidity when performed by experienced endoscopic sinus surgeons. Our experience in managing this condition is presented.