外伤性迁延性脑脊液鼻漏的病因及定位诊治研究

目的探讨脑脊液鼻漏的病理机制、定位诊断及治疗方法。方法总结分析21例外伤性迁延性脑脊液鼻漏的术前CT、CT脑池造影(CTC),与术中所见相比较,评估其诊断价值,从而术前准确定位漏口。结果术中见17例患者神经组织疝入鼻安,16例CT扫描显示骨缺损,所有病例CTC所显示漏口与术中所见完全一致。所有病例术后无复发,无手术并发症。结论神经组织经颅底缺损疝入鼻窦为外伤后脑脊液鼻漏不能自愈的重要病理机制,南于神经组织的疝入,导致黏膜、硬膜、蛛网膜难以修复。CTC可准确确定瘘口部位,4周内不能自愈的脑脊液鼻漏应积极早期手术治疗。

Mechanism and localization of traumatic delayed cerebrospinal fluid rhinorrhea and its diagnosis and treatment

Objective To explore pathologic mechanismof cerebrospinal fluid rhinorrhea,and localize diagnosis and treatment method. Methods Retrospective analyses of 21 cases of traumatic delayed cerebrospinal flud rhinorrhea tested with CT and CT cisternography (CTC)before surgery were selected for the study .The results were compared with the surgical findings for estimating the diagnostic value. Therefore to locate leakage correctly before surgery. Results Neural tissue herniation into nasal sinus was found in 17 cases during operating. 16 cases showed bone defects with CT scanning. The leakages of all cases scanned by CTC were the same found in operation. All cases had no recurs and complication. Conclusion Neural tissue into nasal sinus after the skull base defects was the important pathology mechanism for recovery difficultly of traumatic cerebrospinal fluid rhinorrhea. The nervous tissue into nasal resulted in recovery difficultly of mucous membrane, dura, arachnoid .CTC could locate leakage accurately. If cerebrospinal fluid rhinorrhea cannot be cured itself within four weeks, it should be treated with operation the sooner the better.