听神经瘤术后脑脊液漏的原因及防治

The Causes and Treatment for Cerebrospinal Fluid Leak after Microsurgical Removal of Vestibular Schwannomas

目的探讨经枕下乙状窦后入路听神经瘤切除术后脑脊液漏发生的原因及防治措施.方法回顾性分析本科经枕下乙状窦后入路完成的258例听神经瘤病历资料,术后24例患者出现脑脊液漏,其中19例患者出现脑脊液鼻漏,5例出现脑脊液切口漏,发生脑脊液漏者行保守或手术治疗.结果 18例经过保守治疗治愈,6例经手术修补成功,其中5例一次修补成功.随访14月～8年,平均3.6年,均未见脑脊液漏和迟发脑膜炎发生.结论脑脊液漏是听神经瘤术后常见的并发症,最常见的原因是内听道后壁磨除后开放了颞骨岩部的气房,其次是开放了颞骨乳突及岩部外侧的气房或鼓室,因此在术中应注意颞骨岩部气房的封闭.听神经瘤术后脑脊液漏大部分可通过保守治疗治愈,少部分需行脑脊液漏修补术.

Objective To explore the causes and treatment for cerebrospinal fluid（CSF） leak after microsurgical removal of vestibular schwannomas（VS） with the suboccipital retrosigmoid approach. Methods A retrospective study was accomplished on 258 patients with VS operated through the suboccipital retrosigmoidal approach from Jan 1994 to Aug 2003. After operation, cerebrospinal fluid rhinorrhea occurred in 19 cases and subcutaneous retroauricular CSF leak occurred in 5 cases. Results In 14 cases the CSF leak was stopped after treatment by external lumbar cerebrospinal fluid drainage （CELCFD）. Six patients were operated again with sealing the internal acoustic meatus and the mastoid cells with fibrin glue and muscle. The patients were followed up for 14 months to 8 years after treatment, and there was no recurrence of CSF leak or delayed onset meningitis. Conclusion CSF leak was the common complication after vestibular schwannoma removal and the most common reason was the drilled posterior wall of the internal acoustic meatus with opening of the mastoid cells. The closure of petrous air cells was very important to prevent its postoperative CSF leak. Most of the patients were successfully treated by external lumbar cerebrospinal fluid drainage and only a few cases needed revision surgery.