显微镜联合神经内镜下创伤性脑组织鼻漏手术治疗探讨

Surgery of traumatic cranionasal encephalocele by microscopy and endoscopy

目的探讨显微镜联合神经内镜行颅底重建治疗创伤性脑组织鼻漏的手术疗效及应用价值。方法回顾性分析武警广东总队医院神经外科自2009年6月至2012年6月收治的16例创伤性脑组织鼻漏患者的临床资料，患者均在显微镜下采用带蒂骨膜筋膜瓣和钛网、生物胶等行颅底重建，再用神经内镜经鼻腔检查、完善，术后随访5～36个月观察疗效。结果16例患者中13例恢复良好，未再出现脑脊液漏和脑膜膨出；1例因原发脑损伤伤情过重死亡；2例出现脑脊液漏，其中1例因原发脑损伤伤情重和颅内感染死亡，1例经腰大池置管引流2周后治愈。结论在显微镜和神经内镜联合下行颅底重建对脑组织或脑脊液鼻漏的疗效提高具有重要意义。

Objective To explore the surgical technique of traumatic cranionasal encephalocele by microscopy and endoscopy. Methods The clinical data of 16 patients with traumatic cranionasal encephalocele, admitted to our hospital from June 2009 to June 2012, were analyzed retrospectively. Anterior skull base defects in all patients were reconstructed by continuous vascularized pericranium and tanium mesh, and the operation was performed under microscopy and endoscopy. Follow-up was performed for 5-36 months. Results Of the 16 patients, 13 recovered well without complication; one died of heavy head injury; two had cerebrospinal fluid leakage, including one cured after treating lumbar cistem drainages and one died resulting from intracranial infection. Conclusion Skull base reconstruction by the microscopy and endoscopy can improve the curative effects.