侧颅底术后持续性脑脊液耳漏的治疗与预防

目的 :总结侧颅底手术后持续性脑脊液耳漏的发病原因、手术处理和预防措施。方法 :根据原发病及原手术类型 ,本次手术采用不同的方法 :乳突入路探查 3例 ,耳后联合迷路入路及耳后联合颅中窝入路岩尖胆脂瘤切除并脑脊液漏修补术各 1例 ,乙状窦后入路探查 2例 ,颞部原切口入路肿瘤切除并脑脊液漏修补术 3例。结果 :外漏口位于乳突尖 3例 ,内听道 3例 ,颅中窝硬脑膜缺损表现为外耳道内口漏 3例 ,外耳道后壁肿瘤残留破坏 1例。 9例一次修补成功 ,1例行两次修补。全部病例均经手术治愈。结论 :颅底手术方式不同 ,术中预防和处理耳漏的侧重点应有不同。乙状窦后入路术中应注意保护乳突后及乳突尖气房 ,如有破损应及时封堵 ;迷路入路应处理好内听道、鼓室及咽鼓管黏膜 ,视情况刮除并封堵中鼓室 ;颞骨全切及次全切除术中应修补缺损的硬脑膜和缝合封堵咽鼓管咽口

Management and prevention of persistent cerebrospinal fluid otorrhea induced by lateral skull base surgery

Objective: To summarize the pathogenesis, operative management and prevention of persistent cerebrospinal fluid otorrhea induced by lateral skull base surgery. Method:Based on the primary diseases and operations, different surgeries for the otorrhea repair were performed as follows: three cases by the mastoidal approach; one case by post-aural combined with translabyrinthine approach ; one case by post-aural combined with middle cranial fossaa access;two cases by retrosigmoidal approach; one case by the original incision approach. Result:The leak locations were mastoidale in four cases, internal auditory meatus in three cases, external auditory meatus in three cases due to dural defect of middle cranial fossa and post-infra wall of external auditory meatus of one case. All cases were repaired successfully ,including one case repaired twice. Conclusion:Management and prevention of CSF otorrhea are different according to different skull base surgeries. Mastoid air cells should be focused for retrosigmoidal approach, internal auditory meatus for translabyrinthine approach ,the repair of dura defect and closure of eustachium for total and subtotal petrosal removal.