颞骨脑脊液漏27例的外科治疗总结  

Surgical management of 27 cases with temporal bone cerebrospinal fluid leakage

作　　者：陈晓红[1] 李伟 李海同[1] 戴春富 CHEN Xiaohong;LI Wei;LI Haitong;DAI Chunfu(Department of Otorhinolaryngology,the Second Hospital of Jiaxing,Jiaxing,314000,China;Department of Otorhinolaryngology Head and Neck Surgery,Eye Ear Nose and Throat Hospital,Fudan University)

机构地区：[1]嘉兴市第二医院(嘉兴学院附属第二医院)耳鼻咽喉科,浙江嘉兴314000 [2]复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2021年第11期998-1003,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:总结分析27例颞骨脑脊液漏患者的诊断及外科治疗。方法:回顾性分析27例颞骨脑脊液漏患者的临床资料,根据漏口部位以及患耳听力状况,采用不同的手术方案。术前漏口定位明确者经乳突径路或中颅窝径路直接修补伴或不伴乳突腹部脂肪填塞。漏口不明确、病变范围大或顽固性颞骨脑脊液漏患者,行岩骨次全切除术+腹部脂肪填塞。病变累及耳蜗者,行颞骨次全切除术+腹部脂肪填塞。结果:颞骨脑脊液漏的原因:内耳畸形患者13例;头外伤和手术后继发5例;特发性颅内高压和脑膜脑膨出5例;内耳感染2例;颞骨朗格汉斯组织细胞增多症2例。13例内耳畸形患者颞骨高分辨CT(HRCT)示内听道底骨质缺损同前庭交通;其余14例患者颞骨HRCT显示中颅窝或后颅窝骨质缺损,12例颞骨MRI显示脑膜连续性中断伴脑脊液流入颞骨或脑膜脑膨出。26例术后随访6个月~6年,1例患者失访。仅1例内耳畸形患者术后脑膜炎复发,行岩骨次全切+腹部脂肪填塞。7例患者术后听力保留或改善。所有患者均未出现严重的并发症,其中仅1例患者经乳突前庭池填塞术后出现HBⅡ级面瘫,面瘫1周内恢复。结论:颞骨脑脊液漏发病率低,保守治疗无效时应尽早采取外科干预措施。术前颞骨HRCT和MRI检查有利于漏口的定位,术式选择根据漏口的位置和病变性质不同采取个体化的手术方案。Objective: To study the clinical manifestations and surgical treatment of temporal bone cerebrospinal fluid leakage. Methods: The clinical data of twenty seven cases with temporal bone cerebrospinal fluid leakage were analyzed retrospectively. Different surgical procedures were adopted according to the location of the leak and the hearing status of the affected ear.If the leakage location was clear before surgery, direct repair was performed via mastoid path or middle cranial fossa path with or without mastoid abdominal fat packing.For patients with unclear leak, large lesion or intractable CEREBROspinal fluid leakage of temporal bone, subtotal petrosal resection and abdominal fat packing were performed.Subtotal temporal bone resection and abdominal fat packing were performed for patients with cochlear involvement. Results: In this study, cases of temporal bone CSF leakage including 13 cases of inner ear malformation;5 cases secondary to head trauma or previous surgery, 5 cases of idiopathic intracranial hypertension or meningocele, 2 cases of langerhans histiocytosis in the temporal bone and 2 cases of inner ear inflammation. High resolution CT(HRCT) of temporal bone showed bone defect of inner auditory canal with vestibular communication in 13 patients with inner ear malformation.The temporal bone HRCT of the remaining 14 patients showed bone defects in the middle cranial fossa or posterior cranial fossa, while MRI of the temporal bone showed meningeal continuity interruption with cerebrospinal fluid inflow into the temporal bone or meningoencephalocele in 12 patients. The 26 patients were followed up from 6 months to 6 years. 1 patient lost follow-up.Meningitis recurred in only 1 patient with inner ear malformation, and subtotal resection of rock bone plus abdominal fat packing was performed.Postoperative hearing was preserved or improved in 7 patients.None of the patients had serious complications, and only 1 patient developed HB Grade Ⅱ facial paralysis after vestibular obliteration, and the facial paralys

关 键 词：脑脊液耳漏 脑脊液鼻漏 内耳畸形 高分辨CT MRI 脑脊液漏修补 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]