外伤性迟发性脑脊液鼻漏的诊断和治疗

目的 探讨外伤性迟发性脑脊液鼻漏的发病原因及临床诊治特点.方法 回顾性分析中山大学附属第一医院院2000-2008年收治的13例外伤≥3个月后出现脑脊液鼻漏患者的临床资料,重点分析术前CT及MRI扫描的结果 ,结合术中所见,分析两者之间的关系.结果 13例患者颅底均有陈旧性骨折,MRI扫描显示其中11例有软组织自颅底缺损处疝入鼻窦.术中鼻内镜检查见骨质缺损最小约为0.1 cm×0.2 cm;最大约为1.2 cm×1.5 cm,漏口部位与CT检查结果 一致,其中11例漏口处可见暴露的硬脑膜及坏死组织.所有病例均采用经鼻内镜下脑脊液鼻漏修补术,术后随访12～36个月,未见复发.结论 脑膜组织经颅底缺损疝入鼻窦为外伤后脑脊液鼻漏迟发的关键因素,CT、MRI检查有助于明确漏口位置,其治疗宜采用鼻内镜下脑脊液鼻漏修补术.

Diagnosis and treatment of traumatic delayed cerebrospinal fluid rhinorrhea

Objective To explore the etiological factor,diagnostic localization and treatment of delayed cerebrospinal fluid(CSF)rhinorrhea.Methods The medical records of 79 patients who had undergone endoscopic repair of CSF rhinorrhea between 2000 and 2008 were reviewed.Thirteen patients with CSF leaks occurred 3 months after head trauma.All 13 patients with delayed CSF leak were retrospectively evaluated with CT or MRI and SHrgically treated.The operative findings were compared with the results of CT or MRI to estimate the diagnostic value of imaging technique.Results Bonv defects had been found on CT scanning in all 13 patients.Neural tissue herniation into the nasal sinuses was found in 11 patients during the surgery.The sizes of the leak ranged from 0.1 cm×0.2 cm to 1.2 cm×1.5 cm.Reconstruction of the skull base was done throush endoscopic approach.No complications were found.Thirteen patients were followed up from 12-36 months.and none was recurrence.Conclusions Herniation of mucosal tissue into the nasal sinuses after skull base defects could result in delayed CSF leak.CT and MRI can clearly show the skull base defects and neural tissue herniation.Endoscopic closure of CSF leaks was both safe and effective.