延迟性脑脊液鼻漏32例临床分析  

An analysis of 32 cases with delayed cerebrospinal fluid rhinorrhea

作　　者：王诚[1] 邵君飞[1] 

机构地区：[1]南京医科大学附属无锡市人民医院神经外科,江苏省无锡市214023

出　　处：《江苏医药》2017年第22期1612-1614,共3页Jiangsu Medical Journal

摘　　要：目的总结延迟性脑脊液鼻漏的诊断与治疗。方法回顾性分析32例延迟性脑脊液鼻漏患者的临床资料。结果32例中,外伤13例,鞍区肿瘤经蝶入路术后11例,空蝶鞍综合征3例,双额底脑膜瘤术后1例,蝶骨嵴脑膜瘤术后1例,桥小脑角脑膜瘤术后1例,三叉神经微血管减压术后1例,面神经微血管减压术后1例。18例保守治疗获得痊愈。12例行手术治疗,术前通过MRI获得漏口位置,显微镜下经鼻蝶窦入路修补6例,额部冠状切口开颅4例,经鼻内镜入路修补1例,经鼻蝶窦入路修补、翼点入路硬脑膜下修补二次手术者1例。痊愈29例。失访2例,死亡1例。结论冠状CT扫描和MRI可确定漏口部位,延迟性脑脊液鼻漏保守治疗失败患者采用适宜的外科手术治疗,效果满意。Objective To summarize the diagnosis and treatment of delayed cerebrospinal fluid（CSF）rhinorrhea.Methods The clinical data of 32 patients with delayed CSF rhinorrhea were reviewed retrospectively.Results The causes of CSF rhinorrhea in 32 cases were trauma in 13 cases,postoperative sellar region tumor transsphenoidal approach in 11 cases,empty sellar syndrome in 3 cases,postoperative fronto basal meningioma in 1 case,postoperative sphenoid ridge meningioma in 1 case,postoperative cerebellopontine angle meningiomas in 1 case,postoperative trigeminal microvascular decompression in 1 case,and postoperative microvascular decompression of facial nerve in 1 case.Eighteen cases were cured by conservative therapy.Localized by coronal CT scan and MRI,12 patients were treated by surgery,which was performed with transsphenoidal approach microscopically in 6 cases,with frontal coronal craniotomy in 4 cases,with transnasal endoscopic approach in one case,and with transsphenoidal approach and pterional approach subsequently in one case.Twenty-nine cases were cured,two cases lost follow up,and one case died.Conclusion A proper surgery should be taken under microscope and localized by coronal CT scan and MRI in the patients with delayed CSF rhinorrhea,who are failed to conservative therapy.

关 键 词：脑脊液鼻漏 

分 类 号：R651[医药卫生—外科学]