外伤性颅底骨折致脑脊液漏的发生及处理

目的:探讨脑脊液漏在颅底骨折时的发生率、部位、时间及治疗方法。方法:回顾分析近18年来收治的358例颅底骨折患者的临床资料。结果:脑脊液漏的发生率为24.58%(88/358)。发生于前颅窝56例,中颅窝23例,前中颅窝9例。57例在外伤后48 h内发病,占63.64%,最迟者外伤后28年才发病。88例脑脊液漏中,73例经保守治疗痊愈,11例经一次手术痊愈,3例经二次手术痊愈,1例经三次手术后,因颅内感染呼吸循环衰竭死亡。15例手术治疗中,4例在鼻内窥镜下经鼻行脑脊液漏修补一次成功。结论:颅底骨折部位及脑脊液漏发生时间决定了治疗方案的选择,并与疗效直接相关。鼻内窥镜下手术具有副损伤小,瘘孔定位准确,手术反应轻等优点,值得推广。

Cerebrospinal fluid leak after traumatic skull base fracture: the cause and treatment

Objective: To study the incidence rate,position and time of cerebrospinal fluid(CSF) leak after traumatic skull base and explore a more effective treatment.Method: The clinical data of 358 patients with traumatic skull base fracture were retrospectively analyzed.Results: CSF leak was found in 88 cases((24.6%),)56 of whom resulted from anterior cranial fossa,23 from cranial fossa media,and 9 from anterior-middle cranial fossa.About(64.8%) of the CSF leak(57 cases) occurred in 48 hours after fracture,and the latest was found 28 years after fracture.CSF leak was cured by conservative treatment in 73 patients,by once operation in 11,and by twice operations in 3.One patient died of breathing and circulating exhaustion induced by the infection of intracranial part after three times surgeries.Among participants with surgery,4 was successfully repaired by endoscopy.Conclusion: The response rate of CSF leak seems to have a relationship with the position and duration of fracture.Nasendoscopy has salutary effect on CSF leak for its less side-effect and exact operation.