外伤性颅底骨折所致脑脊液漏的处理及预后因素分析

目的分析影响外伤性颅底骨折所致脑脊液漏愈合的相关因素,以探索外伤性脑脊液漏更好的治疗策略。方法回顾性分析2000年2月至2009年4月期间收治的外伤后颅底骨折所致的脑脊液漏患者的临床资料,收集患者基本信息,入院时GCS评分,脑脊液漏的类型(鼻漏、耳漏)、治疗方式(保守治疗、腰大池引流、手术),有无颅内感染、脑脊液漏预后状况等相关临床资料,采用SPSS软件统计分析可能影响脑脊液漏愈合的相关因素。结果 83例脑脊液漏患者中,男性患者55名,女性患者28名,年龄16~73岁,平均43.8±17.3岁。其中11例患者因颅内合并伤(颅内血肿、神经损伤等)、广泛性颅底骨折、严重的脑脊液漏等行急诊手术治疗,39例患者采用保守治疗脑脊液漏愈合,31例采用腰大池置管引流愈合,2例经保守观察及腰大池引流治疗后仍未治愈行开颅手术修补后愈合。治疗效果满意,无死亡病例,仅1例颅内感染病例。影响脑脊液漏愈合相关因素包括:患者年龄、入院时GCS评分、脑脊液漏的类型。结论多数外伤性脑脊液漏经保守治疗或腰大池置管引流治疗后可愈合,因合并伤需要手术、颅骨广泛性骨折、脑脊液漏严重者需尽早手术治疗。

Treatment of cerebrospinal fluid leak caused by traumatic skull base fracture and prognostic factors

Objective To investigate the influencing factors for the healing of cerebrospinal fluid (CSF) leak due to traumatic skull base fracture,and to explore better therapeutic strategies for traumatic skull base fracture.Methods A retrospective analysis was performed for the clinical data of patients with CSF leak due to traumatic skull base fracture who were admitted to our hospital from February 2000 to April 2009,including basic information,Glasgow Coma Scale (GCS) score on admission,type of CSF leak (rhinorrhea or otorrhea),treatment modality (conservative treatment,lumbar drainage,and surgery),presence or absence of intracranial infection,and outcome of CSF leak.SSPS software was used to analyze the influencing factors for the healing of CSF leak.Results There were 55 male and 28 female patients with CSF leak,aged 16-73 years (mean 43.8 ± 17.3 years).Of all patients,11 underwent emergency surgery due to intracranial injury (intracranial hematoma and nerve injury),extensive skull base fracture,and severe CSF leak;39 underwent conservative treatment of CSF leak and were cured;2 were cured by craniotomy after conservative observation and lumbar drainage.All patients achieved a satisfactory outcome;no patient died,and only 1 patient had intracranial infection.Patient age,GCS score on admission,and type of CSF leak were influencing factors for the healing of CSF leak.Conclusions Most patients with traumatic CSF leak can be cured by conservative treatment or lumbar drainage.Surgery should be performed for patients with injuries which need surgery,extensive skull base fracture,and severe CSF leak.