一期手术治疗前额凹陷前颅底粉碎性骨折并脑脊液鼻漏

The surgical treatment for the depressed forehead and frontal skull base fracture with CSF rhinorrhea

目的介绍一期手术治疗前额凹陷前颅底粉碎性骨折并脑脊液鼻漏的体会。方法对5例病人施行一期手术。预留前额部带蒂膜瓣,电灼额叶底创伤部位蛛网膜,使局部蛛网膜下腔闭合。修补硬膜裂伤,并用生物胶与骨膜瓣粘合;修复前颅底骨缺损,恢复其对额底硬膜的支撑和密闭性。结果全组病人均治愈,前额部观满意。5例脑脊液鼻漏,术后有4例停止,1例减少,经保守治疗后,亦停止。随访3～6月,无复发。结论闭合受损局部的蛛网膜下腔,修补硬膜裂伤;修复或重建前颅底骨缺损,是手术成功的关键。

Objective To introduce the clinical experience of the primary treatment for the depressed forehead and the frontal skull base fracture with CSF rhinorrhea.Methods 5cases were treated with primary repair,coagulating the injured arachnoid membrane in order to close the local subarachoid space with the depressed forehead flap preserved;adhering the lacerated dura with biological glue to the bone flap;re pairing thr defect of the frontal skull base in order to support the frontal dura and close the cranial space.Re sults4cases with CSF rhi-norrhea were cured and1case recovered through surgical or no-surgical treatment .After3～6months of follow-up,no case recured.Con clu-sion It is key to close the subarachnoid space and to repair the defect of skull base in the operation.[