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目的:总结鼻内镜治疗脑脊液鼻漏的要点及可靠的诊断定位方法。方法:回顾性分析15例脑脊液鼻漏患者,其中外伤引起者10例,医源性4例,原发性1例。其中6例经2～6周保守治疗无明显好转给予经鼻内镜下修补术;2例外伤性脑脊液鼻漏经神经外科开颅修补失败后转入我科手术治疗;1例复杂的多发性颅底骨折并双侧额窦后壁缺损致脑脊液鼻漏,经鼻内镜修补成功(DraftⅢ型)。缺损最大者2.5 cm×1.5 cm,所有患者术前均经实验室生化检查确诊,均予以CT和(或)MRI检查和经鼻内镜检查。10例给予脑池造影结合超薄螺旋CT扫描。结果:所有患者均一次治愈,平均随访时间20个月(8～40个月),无复发。1例术后有轻微头疼,经保守治疗后缓解。脑池造影结合超薄螺旋CT扫描定位精确,10例均经术中确定。结论:鼻内镜下脑脊液鼻漏修补术是外科治疗脑脊液鼻漏的首选术式。脑池造影结合超薄螺旋CT扫描是目前最好的影像学定位方法。随着鼻内镜相关器械质量提高及新器械的开发应用,手术范围可能进一步扩大。
Objective: To summarize the main points of nasal endoscopic treatment of cerebrospinal fluid rhinorrhea and reliable diagnosis and positioning methods. Methods: A retrospective analysis of 15 cases of cerebrospinal fluid rhinorrhea patients, including trauma caused by 10 cases, iatrogenic in 4 cases, primary in 1 case. Among them, 6 cases were treated with conservative treatment for 2 ~ 6 weeks without endoscopic repair; 2 cases of traumatic cerebrospinal rhinorrhea were surgically treated by craniotomy after neurosurgery failure; 1 case complicated with multiple traumatic Skull base fracture and bilateral posterior sinus wall defects caused by cerebrospinal fluid rhinorrhea, successful repair by endoscopic (Draft Ⅲ type). The largest defect was 2.5 cm × 1.5 cm. All patients were diagnosed by laboratory biochemical examination preoperatively. CT and / or MRI and endoscopic examination were all performed. Ten cases were given cisterns with ultrathin spiral CT scan. Results: All patients were cured at one time. The average follow-up time was 20 months (ranged from 8 to 40 months) with no recurrence. One patient had slight headache and was relieved after conservative treatment. Echocardiography combined with ultra-thin spiral CT scan positioning accuracy, 10 cases were confirmed by surgery. Conclusion: Endoscopic rhinorrhea repair of cerebrospinal fluid is the first choice surgical treatment of cerebrospinal fluid rhinorrhea. Echocardiography combined with ultra-thin spiral CT scan is the best imaging method of positioning. With the improvement of the quality of endoscopic instruments and the development and application of new instruments, the scope of surgery may be further expanded.