鼻内镜下脑脊液鼻漏修补术前漏口定位方法

Ventage location in cerebrospinal fluid rhinorrhea under endoscopy in 16 cases

目的探讨经鼻内镜行脑脊液鼻漏修补术前准确定位漏口的方法。方法 16例脑脊液鼻漏患者采用术前鼻内镜检查、多层螺旋CT(MSCT)及其三维重建、SPECT/CT脑脊液断层显像等方法判断漏口位置,并与手术结果对比。结果 14例脑脊液鼻漏患者可于MSCT及三维重建中显示颅底骨质异常,15例经SPECT/CT脑脊液断层显像可见颅底至鼻部有异常放射性浓聚影,4例于术前鼻内镜检查中见有脑脊液漏出。有15例患者术前漏点定位与术中所见一致,1例与术中所见不符,手术修补失败后详细检查为脑脊液耳漏经鼻孔流出。结论经鼻内镜脑脊液鼻漏修补术前采用鼻内镜检查、MSCT及三维重建、SPECT/CT等多种方法对漏口进行综合定位分析,可为手术成功奠定基础。应警惕脑脊液耳漏漏液经鼻腔漏出的可能。

Objective To analyze the sites of cerebrospinal fluid rhinorrhea （CFR） via endoscopic treatment. Methods A total of 16 patients with CFR were included in the retrospective analysis. Preoperative endoscopy, multi-slices spiral CT （MSCT） and 3D reconstruction, and SPECT/CT fusion imaging were performed to determine the ventage location which was analyzed and compared with the surgical findings. Results 14 patients showed bone changes of the skull based on CT imaging and 3D reconstruction. 15 patients had abnormally concentrated radionuclide activity from base of the skull to the nasal part on SPECT/CT fusion imaging. Cerebrospinal fluid （CSF） leakage could be observed in 4 cases via endo- scopic examination. And site in 15 cases proved surgically could be shown by the above examination in localization of the sites of CSF leakage. Only one case, which had a different site surgically proved different from pre-operative examina- tion, was diagnosed as cerebrospinal fluid otorrhea （CFO）. Conclusion Pre-operative endoscopy, multi-slices spiral CT （MSCT） and 3D reconstruction, and SPECT/CT fusion imaging can effectively identify the ventages in surgical treatment of CFR, and lay the foundation for successful diagnosis and treatment. But it is necessary to pay attention to the possibili- ty of CFO when treating CFR.