反复并发细菌性脑膜炎难治性脑脊液鼻漏1例并文献复习  

Surgical treatment of refractory cerebrospinal fluid rhinorrhea with recurrent bacterial meningitis in 1 case and literature review

作　　者：汤继宏[1] 李岩[1] 张兵兵[1] 张利亚[1] 陈旭勤[1] 顾琴[1] 

机构地区：[1]苏州大学附属儿童医院神经内科,215003

出　　处：《中华实用儿科临床杂志》2013年第22期1736-1738,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨反复并发细菌性脑膜炎难治性脑脊液鼻漏的外科治疗方法。方法 分析苏州大学附属儿童医院收治的反复并发细菌性脑膜炎9次并行先天性脑脊液鼻漏修补术4次的1例患儿临床资料，并复习相关文献。结果 细菌性脑膜炎9次发作间期，共进行4次神经外科脑脊液鼻漏修补手术，其中前2次鼻内镜下单鼻孔内入路修补、第3次经额硬膜外入路开颅修补，均失败，第4次鼻内镜下单鼻孔内入路修补联合脑脊液脑室-腹腔分流术，并成功。术后随访3.5年未再复发。结论 对反复并发细菌性脑膜炎的难治性脑脊液鼻漏治疗，除进行鼻内镜下鼻孔内入路修补外，还可尝试加用脑室-腹腔分流术，可使长期慢性代偿性增多的脑脊液分流，更好地降低颅内压，使手术成功。Objective To explore the surgical treatment of refractory cerebrospinal fluid rhinorrhea with recurrent bacterial meningitis. Methods The clinical data of 1 case of a 10-year-old boy who had 9 episodes of bacterial meningitis and underwent 4 surgical repair procedures for congenital cerebrospinal fluid rhinorrbea at the Children＇s Hospital Affiliated to Sooehow University were analyzed, and the related literatures were reviewed. Results During the intervals of 9 episodes of bacterial meningitis, the patient experienced 4 neurosurgieal repairs of cerebrospinal fluid rhinorrhea,including 2 endoscopic repairs via the lateral nasal cavity, a craniotomy approach repair via forehead epidural, and an endoscopic repair in combination with a ventriculo-peritoneal shunt. The first 3 surgeries were all failed, but the final surgery was successful ,with no recurrence of cerebrospinal fluid rhinorrhea or bacterial meningitis in 3.5 years of follow-up. Conclusions For recurrent meningitis and refractory cerebrospinal fluid rhinorrhea,the ventriculo-peritoneal shunt can be considered in addition to conventional nasal endoscopic cerebrospinal fluid repair to eliminate the increased cerebrospinal fluid attributable to long-term chronic compensation, and effectively reduce postoperative intracranial hypertension to make the operation success.

关 键 词：脑脊液鼻漏 细菌性脑膜炎 脑室-腹腔分流术 儿童 

分 类 号：R725.1[医药卫生—儿科]