后颅窝开颅局部引流后脑脊液漏的防治研究

目的探讨后颅窝开颅局部引流后脑脊液漏的防治。方法在后颅窝开颅术后局部引流的441例中，按脑膜是否严密缝合，分为硬膜外引流和硬膜下引流，尽量严密缝合硬膜、肌肉逐层，封闭乳突蜂房或者打开它，局部加压包扎以预防脑脊液漏。对于脑脊液漏患者经反复地伤口加固缝合，腰椎穿刺引流，局部加压包扎，抗感染，糖皮质激素等综合治疗。结果在441例中采取预防脑脊液漏的措施后，仍有48例发生56人次脑脊液漏（10．88％），其中2例分别伴有耳漏和鼻漏，经综合治疗后45例完全治愈，3例因反复脑脊液漏继发颅内感染而死亡。结论经后颅窝开颅局部引流后脑脊液漏是可以防治的。

Prevention and treatment of cerebrospinal fluid leak after local drainage of posterior fossa craniotomy

Objective To explore the prevention and treatment of cerebrospinal fluid(CSF) leak after local drainage of posterior fossa craniotomy. Methods 441 patients who underwent local drainage after posterior fossa craniotomy were divided into extradural or subdural drainage according to the tightness of meninges suture. Attempts to prevent post-operative CSF leak included closing mastoid apiary or un-opening it, tightly suturing the putamen and the muscles, replacing the bone flap and binding up with local compression. Repeated sutures of wound, repeated lumbar puncture drainages, long time compression bandage to the wound, prophylactic antibiotics and glucocorticoids were used to all cases. Results Out of 441 cases, 48 cases still had 56 person-time CSF leaks(10.88%) in spite of the measures taken to prevent them and 2 cases of them were accompanied by otorrhea or rhnorrhea, respectively. Out of these 48 cases, 45 cases were cured after complex treatment but 3 cases died due to encephalic infection secondary to repeated CSF leaks. Conclusion CSF leaks can be prevented and treated through local drainage after posterior fossa craniotomy.