外伤性延迟性脑脊液鼻漏的诊断分型与手术方法选择

Diagnostic typing and surgical approach selection in delayed traumatic cerebrospinal fluid rhinorrhea

目的探讨外伤性延迟性脑脊液鼻漏的诊断分型与手术方法选择的关系。方法回顾性分析54例经手术治疗的外伤性延迟性脑脊液鼻漏病人的临床资料,将其分为4种类型:额窦型22例,筛窦型8例,蝶窦型18例及混合型6例。根据诊断分型选择不同的手术入路进行修补,额下入路30例,翼点入路1例,经鼻内镜修补23例。分析诊断分型与手术方法选择及手术疗效的关系。结果术中均见神经组织突入鼻窦,脑组织疝出部位与术前影像学所示完全一致。手术治愈53例,无效1例,经降颅压、腰大池穿刺等处理后治愈。无严重手术并发症发生。结论根据临床表现和术前影像学资料判断脑脊液积聚情况,对外伤性延迟性脑脊液鼻漏进行诊断分型,进而选择经颅或经内镜手术,可提高手术疗效。

Objective To investigate the relationship between the diagnostic typing and surgical approach selection in delayed traumatic cerebrospinal rhinorrhea. Methods Clinical data of 54 patients with delayed traumatic cerebrospinal rhinorrhea was analyzed retrospectively. The rhinorrhea was diagnosed 4 types： frontal sinus type in 22 patients, ethmoidal sinus type in 8, sphenoid sinus type in 18 and mixed type in 6. Different surgical approaches for skull base repair were selected according to the typing： 30 patients via subfrontal approach, 1 patient via pterional approach and 23 patients underwent endoscopic repair. The relationship between diagnostic typing, surgical approach and its clinical effects was analyzed. Results Neural tissues herniating into the nasal sinus were detected intraoperatively in all patients, and the herniation sites were consisted with the preoperative imaging outcomes. Fifty three patients were cured, and 1 patient who had no effect was cured after decreasing intracranial pressure and puncture of lumbar cistern treatment. No severe operative complications occurred. Conclusions Typing the delayed traumatic cerebrospinal rhinorrhea according to preoperative imaging outcomes and clinical manifestations, and then choosing proper surgical approaches could improve the surgical outcome.