粉碎性颅底骨折后CCF合并脑脊液漏的治疗策略

Carotid cavernous fistula combined with cerebrospinal fluid leakage in patients with comminutedskull base fracture: treatment strategy

目的探讨粉碎性颅底骨折后颈内动脉-海绵窦瘘(CCF)合并脑脊液漏的治疗策略。方法对9例粉碎性颅底骨折后出现CCF伴明显脑脊液漏的患者应用血管内介入、腰大池穿刺负压持续引流和后期颅骨整复等方法进行综合治疗。结果共治愈8例,1例由于颅脑损伤严重合并心肺衰竭死亡。平均住院时间53 d。颅内严重感染1例,经负压持续引流及抗生素等治疗后痊愈。结论对于粉碎性颅底骨折后CCF合并脑脊液漏的综合治疗,应优先处理血管性损伤,因为这个问题往往最危急,并且它的存在会严重妨碍其他问题的解决;脑脊液漏早期即行保守治疗,最危急的问题解决后行腰大池置管负压持续引流,治愈率、安全性高;后期颅骨整复造成的二次损伤处理更从容,风险更小。

Objective The treatment strategies for carotid cavernous fistula （ CCF ） combined with cerebrospinal fluid leakage in patients with comminuted skull base fracture are investigated.Methods Comprehensive treatments including endovascular surgery, continuous negative pressure lumbar subarachnoid drainage and skull reconstructive surgery were performed in 9 patients.Results Eight patients were cured and 1 patient died of heart and lung failure.The length of hospitalization was 53 d in average.Conclusion Vascular injuries should be treated firstly because they are always urgent and can affect the treatments of other problems;cerebrospinal fluid fistulae should be treated as soon as the urgent risks have been settled and continuous negative pressure lumbar subarachnoid drainage is a safe and effective method.Secondary injury caused by late skull reconstructive operations can be handled more easily with lower risk.