蝶窦内脑膨出并自发性脑脊液鼻漏1例及文献复习

Sphenoid encephaloceles associated with spontaneous cerebrospinal fluid rhinorrhea: case report and review of the literature

目的探讨蝶窦内脑膨出并自发性脑脊液鼻漏的发病机制和手术治疗经验。方法收集我科收治的1例蝶窦内脑膨出并自发性脑脊液鼻漏患者资料,结合文献复习进行临床分析。结果患者因左侧鼻腔反复流出清亮液体就诊;头颅MRI示左侧蝶窦侧壁骨质缺损,蝶窦内含脑组织信号影及脑脊液信号影;入院后行左侧翼点入路硬脑膜修补术;术后患者症状消失。术后随访6个月,未见复发。结论对于蝶窦内脑膨出发病机制目前并不明确,与侧颅咽管形成、蝶窦过度气化、颅内压增高等多个因素有关;术前准确诊断瘘口位置非常重要,同时应选择个体化的手术方式,术后长期随访。

Objective To investigate the clinical characteristics and the mechanism of spontaneous cerebrospinal fluid （CSF） rhinorrhea resulting from sphenoid encephalocele （SE） and its surgical management. Methods The clinical data of one patient with SE associated with spontaneous CSF rhinorrhea were analyzed retrospectively. The related literatures were reviewed. Results The patient presented with intermittent left CSF rhinorrhea and the MRI showed encephalocele in the left sphenoid sinus due to defect of the bone wall of the sphenoid sinus, This patient received transcranial repair of dura defect by surgery through the standard pterional approach. The follow-up of 6 months afte＇r~ the surgery showed that no CSF rhinorrhea recurred. Conclusions The formation of lateral craniopharyngeal canal, the excessive gasification of sphenoid sinus and the increased intracranial pressure may be involved in the pathogenesis of SE associated with spontaneous CSF rhinorrhea. The microsurgery repairing the dura defect has good clinical effect on CSF rhinorrhea, but individualized operative method and preoperative identification of the fitula mouth are very important to successful treatment of spontaneous CSF rhinorrhea resulting from SE.