脑脊液鼻漏的经颅外科手术治疗

目的探讨经颅手术修补脑脊液鼻漏的手术指征和手术方法。方法我科2011年3月至2013年5月共7例经保守治疗无效的脑脊液鼻漏患者,经颅手术治疗。术前测定鼻腔渗液的含糖量和鼻内镜检查确诊,多排头颅CT薄层扫描,并行二维冠状位重建确认漏口位置。手术均取额部冠状切口。修补在硬膜外和硬膜下两个层面进行,还纳嵌顿疝出的脑组织,骨蜡或骨水泥修补颅骨缺损,脂肪填塞硬脑膜漏口,自体筋膜和人工硬脑膜修补硬脑膜缺损,生物蛋白胶加强固定。术后抗感染、支持治疗。结果 7例患者效果均满意,1例患者术后3周左右再次出现少量脑脊液鼻漏,经保守治疗后痊愈。随访1年以上均未见复发。结论多排头颅CT薄层扫描、并行二维冠状位重建对确认漏口位置有重要指导意义。通过对颅骨和硬脑膜两个层面进行手术修补,能有效修补漏口,取得满意疗效。

Transcranial surgery for repair of cerebrospinal fluid rhinorrhea

Objective To investigate the surgical indications and strategy for transcranial surgery for repair of cerebrospinal fluid rhinorrhea.Methods From March 2011 to May 2013, seven patients with cerebrospinal fluid rhinorrhea who were unresponsive to conservative therapy underwent a transcranial surgical repair in our hospital. The sugar content of leaking cerebrospinal fluid was measured and nasal endoscopy was performed to confirm the cerebrospinal fluid leakage. Thin multislice head CT scan and parallel two-dimensional coronal reconstruction were used to confirm the position of leak port. Forehead coronal incision was applied in all patients. Patching for leak ports was performed in both the epidural space and the subdural space, and the incarcerated brain hernia was cleared. Bone wax or bone cement was used to repair the skull defects. Fat patches were used to pack the leak port in the dura mater, and autologous fascia and artificial dura were used to repair the dural defects. Biological fibrin glue was used to strengthen the fixing material. Treatment for postoperative infection and supportive therapy were given to all the patients.Results Satisfactory results were achieved in all seven patients. One patient had a small amount of cerebrospinal fluid leakage about three weeks after the surgery, but was cured by conservative treatment. No recurrence of cerebrospinal fluid leakage was observed in the follow-up longer than 1 year.Conclusions Thin multislice head CT scan and parallel two-dimensional coronal reconstruction play significant roles in confirming the position of leak port. Surgical repairs in both the skull and the dura mater effectively patch the leak ports and produce satisfactory results.