CT脑池造影在脑脊液鼻漏定位中的应用  

Application of CT cisternography in locating the fistula of cerebrospinal fluid rhinorrhea

作　　者：魏晓明 张帆[2] 薛祎腾 张峰[1] 刘利[1] Wei Xiaoming;Zhang Fan;Xue Yiteng;Zhang Feng;Liu Li(Department of Neurosurgery,Affiliated the First Hospital,Harbin Medical University,Harbin,Heilongjiang 150001,China;Department of Anesthesiology,Affiliated the First Hospital,Harbin Medical University,Harbin,Heilongjiang 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,150001 [2]哈尔滨医科大学附属第一医院麻醉科,150001

出　　处：《中国微侵袭神经外科杂志》2019年第12期547-551,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨CT脑池造影(CTC)在定位脑脊液鼻漏漏口中的应用。方法回顾性分析15例术前进行CTC检查的脑脊液鼻漏病人的临床资料,其中4例同时进行CTC和三维稳态进动快速成像(3D-FIESTA)检查。并将检查结果与术中所见进行对比。结果根据CTC检查结果分型:脑室脑池型13例,脑池型1例,脊髓型1例。所有病人未出现过敏等相关并发症。术前CTC和3D-FIESTA检查发现漏口16个,其中与术中所见一致15个,与术中不一致1个。4例进行CTC和3D-FIESTA检查中,两者定位漏口的结果均一致。本组经鼻内镜修补漏口8例,经硬膜外修补3例,经硬膜下修补4例。所有病人在术后鼻漏停止,随访1~12个月,平均7个月,鼻漏复发1例,嗅觉减退1例。结论建议CTC检查时间一般为90 min。将造影结果分为3型,通过肉眼、CT值或体位变化确定漏口。CTC与3D-FIESTA结合可以相互补充,更准确定位漏口。Objective To explore the application of CT cisternography(CTC)in locating the fistula of cerebrospinal fluid(CSF)rhinorrhea.Methods Clinical data of 15 patients with CSF rhinorrhea undergoing CTC examination before the operation were analyzed retrospectively,and CTC and three-dimensional fast-imaging employing steady state acquisition(3D-FIESTA)examination were performed simultaneously in 4 patients.The examination results were compared with the intraoperative results.Result According to the CTC results,the patients were divided into ventricular cistern type in 13,cistern type in 1 and myeloid type in 1.No patients suffered allergies or other complications.Preoperative CTC and 3D-FIESTA examination found 16 fistulas,15 were consistent with intraoperative findings and 1 was inconsistent with intraoperative findings.Four patients underwent CTC and 3D-FIESTA examination,and the results were consistent.In this study,the fistulas were repaired under endoscope in 8 patietns,via epidural repair in 3 and via subdural repair in 4.Rhinorrhea disappeared in all patients after the operation.The mean follow-up time was 7 months,ranged from 1 to 12 months.CSF rhinorrhea recurred in 1 patient and anosmia in 1.Conclusions It is suggested that the time of CTC examination should be 90 minutes.The results of contrast is divided into three types.The fistula is determined by naked eyes,CT values or body position changes.The combination of CTC and 3D-FIESTA can complement each other and locate the fistula more accurately.

关 键 词：脑脊液鼻漏 CT脑池造影 三维稳态进动快速成像 定位 

分 类 号：R651.1[医药卫生—外科学]