外伤性脑脊液鼻漏的术前定位及手术治疗

我院1996年1月-2003年12月手术治疗外伤性脑脊液鼻漏患者16例。现报告如下。     

外伤性脑脊液鼻漏的诊治

1997年11月-2007年1月,我科收治脑脊液鼻漏患者18例,6例经保守治疗,11例行鼻内镜于术联合鼻外入路,1例行神经外科颅内入路而治愈,现报告如下.     

外伤性迁延性脑脊液鼻漏的诊治

脑脊液鼻漏是颅脑外伤中常见的并发症，其发生率约为2％～9％。急性期脑脊液鼻漏大多数在1周左右自行封闭愈合，迁延不愈的脑脊液鼻漏可达数周或数月，可引起反复的颅内感染。手术是治疗迁延不愈脑脊液鼻漏惟一有效方法，而漏口定位是手术治疗的前提，术式及修补材料是手术成功的关键。     

外伤性脑脊液鼻漏的手术治疗进展

外伤性脑脊液鼻漏（traumatic cerebrospinal rhinorrhea,TCR）是颅脑损伤的合并症之一,由于颅腔的密闭性被打破,颅内与外界相通,属于开放性颅脑损伤范畴,部分患者尚需脑脊液漏修补术。近年来随着科学技术的不断发展,在TCR的手术治疗方面取得了一些新的进展,本文对此做一综述。     

MSCT结合CTC技术对外伤性脑脊液鼻漏的定位研究

目的：探讨MSCT结合CTC技术在外伤性脑脊液鼻漏漏口定位中的价值。方法：选取16例外伤性脑脊液鼻漏患者，术前经多层螺旋CT结合脑池造影进行检查定位，总结检查技术要点，分析其影像表现特征，并与手术结果进行对比。结果：16例CT均显示颅底骨质改变。其中13例经CTC可直接显示漏口位置，与手术所见完全一致。2例结合鼻棉拭测定进行扫描，可显示漏口位置，与手术所见一致。1例CTC仅发现1处漏口，手术发现为2处漏口。结论：MSCT结合CTC技术是CSF鼻漏漏口定位的一种安全、有效的检查手段，对CSF鼻漏的手术治疗具有重要意义，是术前应首选的检查方法。     

大网膜颅内移植治疗外伤性脑脊液鼻漏

病例男，４０岁，被粗钢绳击伤前额，当即昏迷，２小时后入院。查体：昏迷，双瞳等大，前额有一约１０ｃｍ×１０ｃｍ不规则的头皮挫裂伤，颅骨片及碎化脑组织外溢。即在全麻下行清创缝合术。术中清除粉碎的颅骨片和碎化的脑组织。硬膜用筋膜片修补。术后恢复顺利，切口Ⅰ...     

自发性脑脊液鼻漏

本文报告3例自发性脑脊液鼻漏,其病因均系先天性异常,瘘口位于筛板上。其中一例系原发性鼻内脑膜脑膨出。经额开颅,修补瘘口,2例成功,1例失败。结合文献,对本病的分类与发病机理、诊断与瘘口定位及治疗进行了讨论。     

13例外伤性脑脊液鼻漏的诊断及手术治疗

外伤性脑脊液鼻漏是指脑脊液通过前颅窝骨折或缺损及破裂的硬脑膜形成的通道，经其下方的鼻窦或鼻腔而流出颅外，是颅脑外伤所致颅底骨折后常见的并发症。多数的患者经保守治疗可治愈，小部分患者需开颅手术治疗。我院神经外科2002年3月-2005年11月手术治疗13例患者，均采用经前颅窝底硬膜外入路，取得良好的效果。现报告如下。     

脑脊液鼻漏的鼻内镜修补术

1999—2002年经鼻内镜用肌肉筋膜行脑脊液鼻漏修补21例，取得较好疗效，总结如下：     

颅脑创伤急诊手术同期治疗外伤性脑脊液鼻漏38例

外伤性脑脊液鼻漏是颅脑损伤重要的并发症,尤其在前颅窝骨折的患者中,发生率高达39%.一般认为,对于保守治疗1周以上不愈者,可考虑采取手术治疗[1].然而,部分脑脊液鼻漏合并有需要急诊手术治疗的颅内血肿、开放性颅脑损伤等情况,可考虑在急诊手术处理上述损伤的同时行脑脊液鼻漏的修补[2].笔者1998年-2008年在颅脑创伤急诊手术同期修补外伤性脑脊液鼻漏38例.现报告如下.     

脑脊液鼻漏的CT扫描技术

脑脊液鼻漏的ＣＴ扫描技术李小光，范焱，曲来泽脑脊液鼻漏是指脑脊液经异常通道流入副鼻窦、鼻腔形成的漏。脑脊液鼻漏通常由外伤，肿瘤术后以及肿瘤破坏等原因所致。它给患者带来了很大的痛苦，ＣＴ扫描技术的好坏，对临床诊断和治疗起着重要的指导作用。一、资料与设备...     

脑脊液鼻漏的MR诊断价值

目的　探讨脑脊液鼻漏磁共振成像的诊断价值。方法　回顾性分析临床手术证实脑脊液鼻漏患者 16例 ,所有患者均行MR检查 (T2 WI、2DTSE水成像或 3DCISS脑室成像 )及鼻腔流出液糖定量分析。结果　脑脊液漏 14例位于筛窦 ,2例位于蝶窦。所有受检者仰卧位筛窦黏膜及其窦腔内在上均未见明显脑脊液信号 ;改变体位 (脑脊液流出位 )MR扫描 ,可见鼻窦或鼻腔内液体信号积聚。 16例患者中 2DTSE、3DCISS及T2 WI可见筛板、蝶鞍及其周围有线状液体信号向下延伸及筛窦和蝶窦。所有患者鼻腔漏出液葡萄糖定量分析 >3 0mg/L。结论　MR是诊断脑脊液鼻漏有效的方法。优化MR扫描序列和检查方法有利于漏口的显示     

脑脊液鼻漏的CT扫描技术

本文分析了１４例脑脊液鼻漏患者ＣＴ扫描的结果,比较了横断,俯卧冠状扫描和脑池造影扫描对脑脊液鼻漏诊断的价值,充分肯定了高分辨力ＣＴ冠状扫描是显示漏孔最有效和简便的方法,同时认为横断扫描对诊断有一定帮助应作为基础扫描,而脑池造影ＣＴ扫描准确性最高,应在冠状平扫后选用。     

经鼻内窥镜修补脑脊液鼻漏1例

经鼻内窥镜修补脑脊液鼻漏１例武警广东总队医院耳鼻喉科李庆端,李景红（广州５１０５０７）关键词脑脊液,鼻漏患者,男,２０岁。１９９４年１月因车祸致伤头部,昏迷７２ｈ。诊断：重度脑挫伤,左颞部粉碎性骨折,颅前窝、中窝骨折,左额叶硬膜下积气,左颧弓骨折,下...     

Hawkeye SPECT仪融合图像用于脑脊液鼻漏诊断和定位

Objective The purpose of this study was to evaluate the clinical value of the 99Tcm-DTPA cerebrospinal fluid (CSF) Hawkeye SPECT fusion imaging for diagnosing and localizing CSF rhinorrhea (CSFR). Methods Thirty-three patients with suspected CSFR were included in this study. All cases un-derwent planar and SPECT and CT imaging at 120 and 180 min, respectively, after 99Tcm-DTPA injection via lumbar puncture before surgery treatment. The location and path of CSF leakage were diagnosed on pla-nar and SPECT fusion imaging. SAS 6.12 software was used to analyze both sets of imaging data, and the χ2 test was used to compare the results from planar imaging with those of SPECT fusion imaging. Results In 33 patients with CSFR, 31 abnormally concentrated radionuclide activity and location of leakage were foun-ded on SPECT fusion imaging, whereas 30 of such abnormalities were detected by planar imaging. All CSFR cases were confirmed by surgery afterwards. The sensitivity and accuracy for diagnosing and localizing CSFR were 93.9% (31/33), 90.9% (30/33) in SPECT fusion imaging and 93.5% (29/31), 78.3% (18/23) in planar imaging. Conclusion 99Tcm-DTPA CSF Hawkeye SPECT fusion imaging is an efficient, simple and accurate method for diagnosing and localizing CSF leakage.     

Hawkeye SPECT仪融合图像用于脑脊液鼻漏诊断和定位

Objective The purpose of this study was to evaluate the clinical value of the 99Tcm-DTPA cerebrospinal fluid (CSF) Hawkeye SPECT fusion imaging for diagnosing and localizing CSF rhinorrhea (CSFR). Methods Thirty-three patients with suspected CSFR were included in this study. All cases un-derwent planar and SPECT and CT imaging at 120 and 180 min, respectively, after 99Tcm-DTPA injection via lumbar puncture before surgery treatment. The location and path of CSF leakage were diagnosed on pla-nar and SPECT fusion imaging. SAS 6.12 software was used to analyze both sets of imaging data, and the χ2 test was used to compare the results from planar imaging with those of SPECT fusion imaging. Results In 33 patients with CSFR, 31 abnormally concentrated radionuclide activity and location of leakage were foun-ded on SPECT fusion imaging, whereas 30 of such abnormalities were detected by planar imaging. All CSFR cases were confirmed by surgery afterwards. The sensitivity and accuracy for diagnosing and localizing CSFR were 93.9% (31/33), 90.9% (30/33) in SPECT fusion imaging and 93.5% (29/31), 78.3% (18/23) in planar imaging. Conclusion 99Tcm-DTPA CSF Hawkeye SPECT fusion imaging is an efficient, simple and accurate method for diagnosing and localizing CSF leakage.