听神经瘤术后脑脊液漏影响因素和治疗策略

Influential factors and therapeutic strategy for postoperative cerebrospinal fluid leakage in vestibular schwannoma microsurgery

目的探讨听神经瘤术后脑脊液漏的影响因素和治疗策略。方法回顾分析2004年1月～2006年12月共137例听神经瘤手术病例,比较术者经验、手术径路、肿瘤大小、岩骨气化程度对术后脑脊液漏的影响,探讨不同治疗策略。结果术后脑脊液漏发生率6.6%(9/137),按年份统计:2004年为8.3%(2/24),2005年为7.6%(4/53),2006年为5.0%(3/60);按径路统计:迷路径路为7.0%(8/115),乙状窦后为5.6%(1/18),颅中窝、耳囊径路均为0(0/3,0/1);按肿瘤大小统计:I期为0(0/3),II期为3.3%(1/30),III期为6.3%(4/64),IV期为10.0%(4/40);患者术前CT均示岩骨气化程度良好,经保守治疗(9例)和手术脑脊液漏修补(2例)等不同策略治疗后痊愈,无后遗症发生。结论听神经瘤术后发生脑脊液漏,受术者经验、手术径路、肿瘤大小、岩骨气化程度的影响,应及时采用正确策略处理以减少其发生。

OBJECTIVE To investigate influential factors and therapeutic strategy for postoperative cerebrospinal fluid（CSF）leakage in vestibular schwannoma（VS）microsurgery.METHODS A retrospective review was performed in 137 patients with unilateral VS who underwent tumor removal between January 2004 and December 2006.We deemed the surgeon＇ experience,surgical approach,tumor size and petrous bone pneumatization as the influential factors and used the different therapeutic strategy.RESULTS There were totally 9 cases（6.6%）of CSF leakage,which decreased as times goes by（8.3% in 2004,7.6% in 2005 and 5.0% in 2006）,and had close relationship with tumor size（none in stage I,3.3% in stage Ⅱ,6.3% in stage Ⅲ,10.0% in stage Ⅳ）and surgical approach（7.0% in translabyrinthine approach,5.6% in retrosigmoid approach,none in middle fossa and transotic approach）.The preoperative CT scanner showed good petrous bone pneumatization in all these 9 cases.With the medical treatment（9 cases）and surgical salvage（2 cases）,no sequel was found in our series.CONCLUSION The surgeon＇ experience,surgical approach,tumor size and petrous bone pneumatization are the influential factors for postoperative CSF leakage in VS microsurgery.The correct therapeutic strategy is important to reduce its incidence.