经蝶窦显微手术治疗蝶窦性脑脊液鼻漏(附7例报告)(英文)

Transsphenoidal microsurgery on sphenoidal cerebrospinal fluid rhinorrhea: a report of 7 cases

目的探讨经蝶窦显微手术治疗蝶窦性脑脊液鼻漏的手术技巧及经验。方法7例蝶窦性脑脊液鼻漏患者,经4周保守治疗无效后,行经蝶窦入路颅外显微修补术。结果显微镜下凿开鞍底充分暴露硬膜漏口,向硬膜漏口内填塞肌肉块,无脑脊液流出后,用渍ZT胶的明胶海绵填塞于硬膜漏口的内、外侧和蝶窦腔。术后无一例复发。结论这种颅外修补术具有创伤小、并发症少、成功率高的优点,并可同时处理鞍内病变,是修补蝶窦性脑脊液鼻漏的最佳入路。

Objective To discuss the techniques and experiences of treating sphenoidal cerebrospinal fluid rhinorrhea （SR）. Methods Seven patients （5 females and 2 males, mean age of 41 years old） were studied. All patients were diagnosed and localized by radionuclide cisternography. After four weeks＇conservative management, the leakage was still active, then transsphenoidal extracranial rhinological repair was undertaken. Results In operation, the floor of sell around the fistula was debrided adequately to expose the defect in the dura. Then the muscle pack was placed intradural, and the gelfoam soaked with ZT mucilage was tamponed intra- and extra-dural to support the packing. No leakage recurred after repair.Conclusion Transsphenoidal extracranial rhinological repair has advantages of superior exposure of the sellar area , high rate of success, low morbidity and less complications. And it provides optimal approach for repair of sphenoidal cerebrospinal fluid rhinorrhea.