因开放内听道致听神经瘤术后脑脊液鼻漏的显微外科治疗  

Microsurgical treatment of cerebrospinal fluid rhinorrhea after operation of vestibular schwannoma due to the opening of internal auditory canal

作　　者：梁建涛[1] 王旭[1] 宋刚[1] 李茗初[1] 郭宏川[1] 陈革[1] 鲍遇海[1] Liang Jiantao;Wang Xu;Song Gang;Li Mingchu;Guo Hongchuan;Chen Ge;Bao Yuhai(Department of Neurosurgery,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经外科杂志》2019年第5期485-488,共4页Chinese Journal of Neurosurgery

基　　金：北京市医管局"扬帆"计划(XMLX201821).

摘　　要：目的探讨听神经瘤术中因开放内听道致术后顽固性脑脊液鼻漏的外科治疗。方法2012年1月至2018年5月,首都医科大学宣武医院神经外科共完成249例听神经瘤切除术,术后8例(3.2%)出现脑脊液鼻漏,其中5例经腰大池引流、卧床等保守治疗,脑脊液鼻漏消失;3例(1.2%)保守治疗无效,分别于肿瘤切除术后第3、9、28天接受二次开颅脑脊液鼻漏修补术。均经枕下-乙状窦后入路(原切口)行修补术,术中以新鲜肌肉粒和耳脑胶(α-氰基丙烯酸正丁酯)封堵内听道后壁骨质缺损。回顾性分析患者的临床资料和疗效。结果3例接受手术修补的患者中,2例术后脑脊液鼻漏即刻消失,1例术后1个月脑脊液鼻漏消失;修补术后,面神经功能均未受影响,出院时House-Brackmann分级Ⅰ级者2例,Ⅱ级者1例。3例手术修补的患者术后均发生颅内感染,经抗感染后痊愈。结论脑脊液鼻漏是听神经瘤术后较为常见的并发症,部分患者需行二次修补术。严密修补开放的岩骨气房是预防听神经瘤术后发生脑脊液鼻漏的关键。Objective To investigate the microsurgical treatment of refractory cerebrospinal fluid (CSF) rhinorrhea after operation of vestibular schwannoma due to the opening of internal auditory canal. Methods From January 2012 to May 2018, a total of 249 patients with vestibular schwannoma underwent tumor resection at Neurosurgery Department, Xuanwu Hospital of Capital Medical University. There were 8 (3.2%) cases that developed CSF rhinorrhea after operation. Among them, 5 underwent conservative therapy and CSF leakage disappeared and the remaining 3 (1.2%) cases with refractory CSF leakage received second craniotomy for CSF leakage repair on the 3rd, 9 th and 28 th day after tumor resection respectively. Suboccipital retrosigmoid approach (original incision) was used to repair the defect of posterior wall of internal auditory canal. Fresh muscle granules and glue were used to seal the defect of posterior wall of internal auditory canal. Results Among the 3 patients who underwent surgical repair operation, CSF leakage disappeared immediately in 2 cases and cured one month later in 1 case. Facial nerve function was not affected after the second operation. The assessment based on House-Brackman classification revealed grade 1 in 2 cases and grade 2 in 1 case at discharge. All the 3 patients developed intracranial infection and recovered after anti-infection therapy. Conclusions CSF rhinorrhea after vestibular schwannoma surgery is a relatively common complication. Meticulous sealing of opened air cells in the petrous bone (around the inner auditory canal and mastoid air cells) seems necessary for the prevention and treatment CSF leakage.

关 键 词：神经瘤 听 脑脊液鼻漏 显微外科手术 内听道 

分 类 号：R739.41[医药卫生—肿瘤]