伴颅高压的脑脊液鼻漏修补术的围手术期处理

Perioperative management of the patients undergoing repair of cerebrospinal fluid rhinorrhea with intracranial hypertension

目的探讨内镜经鼻入路修补颅高压导致脑脊液鼻漏的围手术期处理。方法回顾性分析8例颅高压导致脑脊液鼻漏的临床资料,鼻漏持续5～150d,平均30d;鼻漏量≥300ml/d4例,鼻漏量<300ml/d4例;伴颅内感染6例,无颅内感染2例。所有病人均采用内镜经鼻入路手术修补,并结合降颅压治疗。结果配合多次腰椎穿刺,反复修补4次成功1例,1次修补成功4例;配合腰大池引流及永久性脑室-腹腔分流术修补2次成功3例。术后随访6～36个月均未见复发。结论内镜经鼻入路辅以腰椎穿刺放液、腰大池引流甚或永久性脑室-腹腔分流术有助于伴有颅高压的脑脊液鼻漏修补术获得成功。

Objective To investigate the perioperative management of the repair for cerebrospinal fluid rhinorrhea（CSFR） resulting from intracranial hypertension via endoscopic endonasal approach.Methods Clinical data of 8 patients with CSFR due to intracranial hypertension was analyzed retrospectively.The time of CSFR ranged from 5 to 150 days with a mean of 30 days.The volume of CSFR exceeded 300 ml/d in 4 cases,and not more than 300 ml/d in 4.The CSFR was accompanied by intracranial infection in 6 patients,and no intracranial infection in 2.Repair of CSFR by endoscopic endonasal approach combined with the treatment of lowering intracranial pressure were performed in all the patients.Results Combined with lumbar puncture,the repair was repeated 4 times in 1 case,once in 4.Combined with lumbar cisterna drainage and perpetual ventriculo-peritoneal（V-P） shunt,the repair was repeated twice in 3 cases.A follow-up of 6 to 36 months was performed,and no case recurred.Conclusions Combined with lumbar puncture,lumbar drainage or perpetual V-P shunt,endoscopic endonasal approach is helpful for intracranial hypertension complicated by CSFR.