经迷路进路听神经瘤术后脑脊液漏的预防及处理

目的　探讨经迷路进路听神经瘤切除术后脑脊液漏发生的影响因素及处理方法。方法1999年以来采用迷路进路或扩大迷路进路听神经瘤切除术 85例 ,前 4 1例采用传统关闭术腔技术 ,后4 4例对关闭技术进行改良 ,分析其脑脊液漏的发生率。发生脑脊液漏者行保守或手术治疗。结果传统关闭技术组中脑脊液漏的发生率为 19 5 % ( 8 4 1) ,改良关闭技术组中脑脊液漏的发生率为 2 3%( 1 4 4 ) ,两组差异有显著性意义 (P =0 0 13)。传统关闭技术组中脑脊液漏多数发生在大型听神经瘤中 ,其发生率随肿瘤增大有上升的趋势。 9例脑脊液漏的患者中 ,3例经保守治疗 ;6例经手术修补成功 ,其中 5例 1次修补成功。结论　改良关闭术腔技术可显著降低经迷路进路听神经瘤切除术后脑脊液漏的发生率 ,手术修补为终止脑脊液漏的有效措施

Prevention and therapy of cerebrospinal fluid leakage after translabyrinthine acoustic neuroma removal

Objective To evaluate the modified wound closure technique and other methods for preventing and treating the cerebrospinal fluid (CSF) leakage after removal of acoustic neuroma by translabyrinthine approach Methods In a series of 85 cases of acoustic neuroma surgery, two kinds of technique of wound closure, the traditional (as first group) and the modified (as second group), have been subsequently used to prevent CSF leakage The incidences of CSF leak were analyzed respectively. Conservative and surgical treatments were applied to treatment the CSF leak Results In the first group, the CSF leak was 19 5%(8/41), and that of second group was 2 3%(1/44) There was significant difference between them( P =0 013) The CSF leak mainly occurred in large acoustic neuromas surgery with traditional wound closure technique Among 9 cases of CSF leaks, 3 were controlled by conservative method, 5 by one single revision surgery and one by two revisions Conclusions The revision technique of wound closure could significantly reduce the incidence of CSF leakage after acoustic neuroma removal by translabyrinthine approach The revision surgery is an effective method for stopping the CSF leak