神经内镜下脑脊液鼻漏的鞍底及前颅底手术修补

Repairing front skull base and saddle bottom of cerebrospinal fluid rhinorrhe under endoscopy

目的探讨神经内镜下修补脑脊液鼻漏及颅底重建的方法和技术要点。方法回顾分析厦门大学附属中山医院神经内镜下脑脊液鼻漏的鞍底和前颅底手术修补26例患者的临床特性、手术治疗特点及随访资料。其中男19例，女7例；平均年龄31．5岁，包括筛窦型6例，蝶窦型14例，混合型6例，无额窦型。结果本组脑脊液鼻漏包括外伤性17例，鞍区术后6例，鼻内镜术后2例，垂体瘤伽马刀术后1例。全部经单鼻孔神经内镜下手术修补治愈，其中1次手术修补成功22例，占84％，2次手术者4例。术后随访时间6个月～4年，平均2年，未出现复发脑脊液鼻漏和新的神经功能缺失。结论神经内镜下脑脊液鼻漏修补成功的关键在于准确定位漏口，牢靠颅底重建和修补材料的固定及术后持续腰池引流的选择应用。经鼻神经内镜下修补脑脊液鼻漏是一个可靠、有效、微创值得推广的手术方法。

Objective To explore the methods and techniques of repairing cerebrospinal fluid （CSF） rhinorrhea and reconstructing the defects of skull base under endoscopy. Methods The clinical data of 26 patients undergoing endoscopic repair of CSF rhinorrhea were analyzed retrospectively. There were 19 males and 7 females with an average age of 31.5 years old. Rhinorrhea was classified into 4 types： ethmoidal sinus type （n =6）, sphenoid sinus type （n =14） and mixed type （n =6） and frontal sinus type （n =0）. Results The causes of rhinorrhea were as follows ： traumatic leakage （ n = 17 ）, post-operative breakage of saddle area （ n = 6 ）, damage after endonasal surgery （ n = 2 ） rhinorrhea after γ-knife for pituitary （ n = 1 ）. All cases were successfully repaired via an endoscopic endonasal approach. Among them, 22 patients were repaired only once while 4 patients with recurrent CSF rhinorrhea were repaired again. The follow-up period was from 6 months to 4 years. And satisfactory outcomes were achieved in all. Conclusion Accurate localization of CSF leakage, reliable reconstruction of skull base, secure fixation of adhesive materials and continuous lumbar CSF drainage are keys surgical techniques. Endoscopic repair of front skull base and saddle bottom of CSF rhinorrhea is a reliable, effective and mini-invasive surgical approach worth further popularization.