成人和儿童自发性脑脊液耳漏差异分析

The diversity analysis of spontaneous cerebrospinal fluid otorrhea between young children and adults

目的:分析成人和儿童自发性脑脊液耳漏在临床表现、CT影像、耳漏部位及手术操作等方面的差异性。方法:6例自发性脑脊液耳漏患者中,成人4例,儿童2例。均采用经乳突入路的手术方式。4例成人患者中,2例漏口位置在乳突盖、1例在鼓室盖、1例在窦脑膜角,内耳结构未见异常,骨质缺损部位采用自体游离肌肉、筋膜、耳脑胶封堵;2例儿童缺损部位在前庭窗且伴有内耳发育异常,瘘口位置采用游离肌肉加筋膜加肌肉分层哑铃型填塞。结果:5例患者均一次手术成功,未再复发;另外1例成人患者左耳术后1年复发、第2次术后2年复发、第3次术后1年半未复发,右耳术后3年未复发。结论:成人和儿童自发性脑脊液耳漏临床表现不同,术前颞骨高分辨率CT对于漏口部位的判断非常重要,特别是成人患者应该明确脑脊液耳漏的位置及漏口数量,对于手术方式的选择具有重要价值和意义。

Objective：To assess the diversity of spontaneous cerebrospinal fluid（CSF）otorrhear in clinical manifestation,CT,leakage sites and surgical operation between young children and adults.Method：We conducted a retrospective study of 6consecutive patients who were all underwent the surgery through the transmastoid approach,including 4adults patients and 2children.In the 4adults patients,two patients＇ bony defects lay on the tegmen mastoideum,one lay on the tegmen tympani,and another one lay on the sinus meningioma angle.None of the 4adults patients had abnormal inner ear structures.Materials used in repair included free muscle graft,temporalis fascia,and fibrin glue of the 4adults patients.The 2children patients were diagnosed with congenital abnormalities of the lateral inner ear,who had bony defects of the foot plate or fenestra vestibule.Materials used in repair included free muscle graft,temporalis fascia,and musclein sequence.Result：No CSF leaks recurred after the operation except one adults patient,who＇s left ear recurred two times and experienced three operations.Conclusion：The clinical manifestations of spontaneous CSF otorrhea between young children and adults are different,the HRCT scan on temporal bone before the operation is very important.Especially foradults patients,making sure of theleakagesites and numbers isvaluable and significance for thesurgical procedure selection.