内镜经鼻浴缸塞技术在儿童脑脊液鼻漏修补术中的应用

“Bath-plug”technique for the endoscopic repair of cerebrospinal fluid leaks in children

目的探讨内镜经鼻浴缸塞技术在儿童脑脊液鼻漏修补术中的安全性和有效性。方法回顾性分析2016年9月—2019年9月北京儿童医院耳鼻咽喉头颈外科收治的16例脑脊液鼻漏患儿的临床资料。其中男10例,女6例,年龄5~123月龄,中位年龄57.5月龄。患儿常规进行鼻窦薄层CT及MRI检查,并进行了全身麻醉下经鼻内镜浴缸塞技术脑脊液鼻漏修补术。术后定期随访,对手术效果及并发症进行评估。对所有患儿的人口学特点、症状、体征、颅底漏口位置及面积、治疗及预后情况等进行归纳总结。结果16例患儿中,外伤性脑脊液鼻漏7例,先天性脑脊液鼻漏9例。单纯性脑脊液鼻漏2例,合并基底型脑膜脑膨出14例。颅底漏口分别为左侧筛板6例,右侧筛板4例,左侧筛顶2例,右侧筛顶1例,左侧额窦后壁2例,右侧蝶窦顶壁1例。漏口最大直径1~4 mm 4例,5~10 mm 7例,11~20 mm 5例。其中15例手术获得一次性成功,仅1例额窦后壁外伤性脑脊液漏内镜手术修补失败,改由神经外科行开颅修补术。术后随访24~60个月,中位随访时间32.5个月,均未复发或出现并发症。结论内镜经鼻浴缸塞技术法儿童脑脊液鼻漏修补术是一种安全、有效的手术方式,具有操作简便、创伤小、并发症少等优点。

Objective To assess the safety and validity of‘bath-plug’technique for endoscopic repair of cerebrospinal fluid leaks in children.Methods Clinical data of 16 patients undergoing endoscopic repair of cerebrospinal fluid leaks utilizing abdominal free fat from Sept 2016 to Sept 2019 were analyzed retrospectively.There were 10 boys and 6 girls,aged from 5 to 123 months with a median age of 57.5 months.Radiological workups and endoscopic procedures with a fat bath-plug were performed for all patients.Patient characteristics,initial presentation,locations and sizes of cerebrospinal fluid leaks,surgical procedures,recurrences,complications at both donor and recipient graft sites were evaluated.Results Of all the patients,7 suffered from traumatic cerebrospinal fluid leaks and 9 congenital cerebrospinal fluid leaks.Fourteen patients presented with cerebrospinal fluid leaks and encephaloceles.The sites of skull base defects included cribriform plate(n=10),ethmoid roof(n=3),posterior wall of frontal sinus(n=2),and sphenoid roof(n=1).The maximum diameter of skull base defects was 1~4mm in 4 cases,5~10mm in 7,and 11~20mm in 5.Of all the patients,15 underwent endoscopic procedures successfully,while one patient required the neurosurgical service to repair a large posterior wall defect of frontal sinus via open transcranial approach.All patients had favorable clinical outcomes without any recurrences or complications during a follow-up of 24~60 months.Conclusion With easy procedure,less injuries and complications,the fat bath-plug technique is safe and effective for the endoscopic repair of both congenital and traumatic cerebrospinal fluid leaks in children.