脑脊液鼻漏经鼻内镜及其与额部联合进路的治疗

目的 总结脑脊液鼻漏的漏口诊断与经鼻内镜及其额部联合进路治疗的临床经验.方法 对58例确诊脑脊液鼻漏患者临床资料作回顾性分析,58例患者均行CT检查寻找漏口.56例患者接受了手术治疗,其中鼻内镜修补45例,对漏口位于额窦后壁及额眶部位的11例进行了经鼻内镜和额部联合进路修补;2例未行手术.56例手术患者中,普通CT扫描31例,其中25例术中证实正确显示漏口;另外25例行螺旋CT薄层扫描并三维重建方法 ,其中23例正确显示;8例术前CT未能显示漏口者均经术中探查明确部位进行治疗.结果 随访6个月至5年,中位随访时间3年.53例1次治愈,一次成功率94.6%,1例2次修补成功,1例先后行5次手术治愈;1例因术后颅内并发症死亡;2例因故未行手术出院失访.结论 螺旋CT薄层扫描图像的三维重建可使脑脊液鼻漏漏口的定位更准确;对发生于额部的脑脊液鼻漏,经鼻内镜和额部联合进路可弥补内镜下操作困难和不足,有助于提高修补的成功率.

Treatment of cerebrospinal fluid rhinorrhea via transnasal endoscopic approach and its combination with frontal approach

OBJECTIVE: To summarize the clinical experience in diagnosing and managing cerebrospinal fluid (CSF) rhinorrhea via transnasal endoscopic approach and its combination with frontal approach. METHODS: A retrospective study of 58 patients with CSF rhinorrhea was conducted. Fifty eight cases were all under CT. Fifty six cases underwent surgical treatment Among them, 45 patients were treated with transnasal endoscopic approach, 11 whose cerebrospinal fistulas located in back wall of frontal sinus and orbital-frontal part with fronto-rhinal approach. Two were without any surgical treatment. Among 56 cases who underwent surgical treatment, 31 cases were under normal CT, of which 25 were accurate. Another 25 cases were under thin-section spiral CT scan and three-dimensional reconstruction, of which 23 were accurate. Eight cases locating the fistulas inaccurately by CT found the fistulas by operation. RESULTS: Postoperative follow-up lasted from 6 months to 5 years, a median follow-up period of 3 years. Among 45 cases with transnasal endoscopic approach, 43 were cured after the first attempt, one was cured after the second attempt; one died because of the intracranial infection. Among 11 cases with fronto-rhinal deossification, 10 were cured after the first attempt, one with orbital-frontal absence after the fifth attempt. Two left hospital and lost following-up without any surgical treatment. CONCLUSIONS: Thin-section spiral CT scan and three-dimensional reconstruction make the leak locating more accurate. Combination of frontal approach may deal with transnasal endoscopic surgery's demerit to the unreachable site and enhance the achievement ratio of the first attempt.