经鼻内窥镜脑脊液鼻漏及脑膜脑膨出手术13例

目的：探讨经鼻内窦镜脑脊液鼻漏及脑膜脑膨出手术的有效性。方法：回顾性研究13例脑脊液鼻漏及脑膜脑膨出的诊断及治疗。结果；13例患者中颅底缺损位于筛顶及额隐窝5例，蝶窦4例，筛板4例。13例中脑膜脑膨出4例，其中3例有外伤史，1例为先天性。经鼻内窥镜手术后随访6-27mo，11例（84.6％）无复发。1例术后10d抽取碘纺纱条时复发，另1例碟窦非霍杰金氏淋巴瘤术后3mo化疗时复发。无手术并发症。结论：经鼻内窥镜手术直视下切除脑膜膨出组织，修补漏口，避免开颅，是治疗脑脊液鼻漏及鼻内脑膜脑脑膨出的理想手术方法。

Endoscopic management of cerebrospinal fluid rhinorrhea and/or nasal meningoencephalocele: 13 cases report

AIM To investigate the efficiency of endoscopic technique in the management of cerebrospinal fluid rhinorrhea and nasal meningoencephalocele. METHODS The diagnosis and management of 13 cases of cerebrospinal fluid rhinorrhea and/or nasal meningoencephalocele were retrospectively studied. RESULTS The defect of skull base was found at the roof of ethmoid cells and frontal recess ( n =5), sphenoid sinus ( n =4) and lamina cribrosa ( n =4). There were 4 cases of nasal meningoencephalocele, 3 of which with trauma and 1 without trauma. Endoscopic approach was applied in 13 cases with success in 11 (84.6%) after one procedure with follow up of 6~27 months. One recurred after removal of iodoform gauze 10 days after operation and one sphenoid non Hodgkin lymphoma recurred during chemistry therapy 3 months after operation. No complications were found. CONCLUSION Endoscopic technique, which provides excellent visualization of protrusion tissue and defect and direct management without transcranial approach, is an ideal operation for cerebrospinal fluid rhinorrhea and intranasal meningoencephalocele.