硬膜不透水缝合法防治后颅窝开颅术后局部积液

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

目的探讨后颅窝术后症状性颈枕部积液的防治经验。方法收集我科2000年1月至2007年1月收治的后颅窝开颅术后出现症状性枕颈部积液23例患者,及2004年1月至2007年1月连续113例采用硬膜不透水缝合法患者的临床资料,评价不同处理方法局部积液情况。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。硬膜不透水缝合法113例无症状性枕颈部积液发生。结论硬膜不透水缝合法是防治后颅凹开颅后脑脊液漏的有效方法。

Objective To summarize the experience leak and pseudomeningocele after posterior fossa surgery. Jan 2007 ） , the clinical course of 23 patients suffered from eraniotomy at Daping Hospital were reviewed. Results during the management of cerebrospinal fluid （CSF） Methods During a seven-year period （Jan 2000 to CSF leak and pseudomeningocele after posterior fossa Overall results were quite satisfactory. Four patients recovered after repeated subcutaneous punctures and pressure dressing. CSF leaks were stopped in seven patients by closed lumbar subarachnoid drainage. Twelve patients underwent repeated surgical repair of their leaks. No patients suffered ongoing or recurrent leakage after reoperation. The application of these management resulted in a total absence of CSF leaks and pseudomeningocele in 113 consecutive patients thereafter. Conclusion A watertight dural closure verified 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 or pseudomeningocele after posterior fossa surgery.