后颅窝开颅术后局部积液的防治

Prevention and treatment of symptomatic cerebrospinal fluid leaks and pseudomeningocele after posterior fossa surgery

目的探讨后颅窝开颅术后症状性颈枕部积液的防治经验。方法收集大坪医院2000年1月至2007年1月后颅窝开颅术后出现症状性颈枕部积液患者23例,及2004年1月至2007年1月改进方法连续113例后颅窝开颅术的局部积液情况。结果早期反复穿刺引流及加压包扎治愈4例,经腰池置管引流治愈7例,再次手术修补治愈12例。技术改进连续113例后颅无症状性颈枕部积液发生。结论耳脑胶薄肌肉块加固有助于不透水缝合,是避免脑脊液漏的有效方法。对已发生者,卧床、早期穿刺抽吸或腰池引流加压包扎部分有效,无效及晚期患者需要再进行手术修补。

Objective To summarize the experience during the management of cerebrospinal fluid （CSF） leak and pseudomeningocele after posterior fossa surgery. Methods During a seven-year period （Jan 2000-- Jan 2007）, the clinical course in 23 cases suffered from CSF leak and pseudomeningocele after posterior fossa craniotomy at Daping Hospital were reviewed. Results Overall results were quite satisfactory. Four patients recovered after repeated subcutaneous punctures and pressure dressing, the CSF leaks were stopped in seven patients by closed lumbar subarachnoid drainage, and twelve of these patients required repeat surgical repair of their leaks. No patient suffered ongoing or recurrent leakage after reoperation. The application of the modifications resulted in a total absence of CSF leaks and pseudomeningocele in 113 consecutive patients thereafter. Conclusion A watertight dural closure vertified by Valsalva maneuver, with the addition of muscle pieces and tissue glue in a ＂plugging＂ fashion, provides a simple and effective technique for the prevention of CSF leakage after posterior fossa surgery. Management of CSF leaks starts with nonoperative measures .including bed rest, subcutaneous punctures and pressure dressing, and placement of a lumbar subarachnoid spinal fluid di- version drain. Repeat exploration for dural repair is necessary when conservative measures fail or those who develop chronic pseudomeningocele.