前颅底骨折后的外伤性迟发性脑脊液鼻漏手术治疗

Diagnosis and surgical treatment of traumatic delayed cerebrospinal fluid rhinorrhea

目的探讨源于前颅底骨折的外伤性迟发性脑脊液鼻漏的诊断和治疗。方法对11例资料完整的前颅底骨折后外伤性迟发性脑脊液鼻漏病例,同时行术前高分辨率螺旋CT(HRCT)颅底骨质薄层扫描三维重建及MR脑池造影(MRC)定位漏口,采用三明治法的筋膜-骨片(肌肉)-筋膜法技术修补漏口。结果 11例患者漏口定位准确,筋膜-骨片(肌肉)-筋膜法技术修补漏口效果确切。结论术前高分辨率螺旋CT(HRCT)联合MR脑池造影(MRC)可以准确定位漏口,去除经颅底骨质缺损处疝出的脑组织,结合带蒂帽状腱膜下骨膜瓣修补重建是脑脊液漏修补成功的关键步骤。

Objective To investigate the leak locating and surgical treatment of delayed cerebrospinal fluid rhinorrhea following trau-matic fracture of the anterior skull base.Methods Preoperative high resolution spiral CT（HRCT）scanning and three-dimensional re-construction of the skull base and MR cisternography（MRC）had been used to locate leakage in 11 cases.The fascia-bone flap（mus-cle）-fascia technique,the so-called sandwich method,had been used in operation.Results Eleven cases of patients with leakage had been located accurately.The sandwich technique operated very well.Conclusions The high resolution spiral CT（HRCT）combined with MR cisternography（MRC）can accurately locate the leakage.Removing the hernia of brain tissue is a key step of successful repair of cerebrospinal fluid leakage.