自发性脑脊液耳漏的临床诊治分析

Clinical diagnosis and treatment analysis of spontaneous cerebrospinal fluid otorrhoea

目的:探讨自发性脑脊液耳漏的临床特点、影像学表现、手术方法及诊治经验。方法:回顾性分析2018年5月至2023年5月手术治疗的11例自发性脑脊液耳漏患者的临床资料,包括既往病史,影像学资料、漏口位置、手术修补方法、治疗效果及术后随访情况等。结果:11例手术患者,其中4例患者首诊为分泌性中耳炎,1例患者首诊为化脓性中耳炎,5例患者既往有脑膜炎病史或因脑膜炎为初次诊断而就诊;经耳道径路修补脑脊液漏2例,经乳突径路修补脑脊液漏9例;术中发现漏口位于镫骨底板4例,窦脑膜角1例,颅后窝合并颅中窝1例,颅中窝4例,内听道底及面神经管迷路段1例;10例患者1次修补成功,另1例患者术后出现颅内高压,最终行侧脑室腹腔分流术后症状解除。术后随访6个月~4年,无脑脊液耳漏及脑膜炎复发。结论:自发性脑脊液耳漏发病率低,临床症状不典型,延迟诊断或漏诊误诊率高;手术是目前治疗自发性脑脊液耳漏首选方法,通常可以取得满意的效果;诊疗过程中要警惕并重视颅内高压的存在,防止发生严重并发症及不可逆损伤。

Objective To investigate the clinical features,imaging findings,surgical methods,diagnostic and treatment experience of spontaneous cerebrospinal fluid otorrhoea.Methods The clinical data of 11 patients with spontaneous cerebrospinal fluid otorrhoea treated surgically at our hospital from May 2018 to May 2023 were retrospectively analyzed.The medical data included medical history,imaging data,leak location,surgical repair method,treatment effect and postoperative follow-up.Results Among the 11 surgical patients,4 patients were initially diagnosed with secretory otitis media,1 was initially diagnosed with purulent otitis media,and 5 patients had a history of meningitis or presented because meningitis as the initial diagnosis.There were 2 cases of cerebrospinal fluid leakage repaired through the ear canal pathway and 9 cases of cerebrospinal fluid leakage repaired through the mastoid pathway.During the operation,leaks were located in the stapes floor plate in 4 cases,sinus meningeal angle in 1 case,posterior cranial fossa combined with middle cranial fossa in 1 case,middle cranial fossa in 4 cases,and labyrinthine segment of the internal auditory canal and facial nerve canal in 1 case.Ten patient was successfully repaired,and another patient developed intracranial hypertension after surgery,with symptoms alleviated by a lateral ventriculoperitoneal shunt.Postoperative follow-up ranged from 6 months to 4 years,and there was no CSF otorrhoea and meningitis recurrence.Conclusion The incidence of spontaneous cerebrospinal fluid otorrhea is low,the clinical symptoms are atypical,and the rate of delayed diagnosis or missed diagnosis and misdiagnosis is high.Surgery is currently the preferred treatment for spontaneous cerebrospinal fluid otorrhoea,and satisfactory results are usually achieved;During diagnosis and treatment,it is crucial to be vigilant for intracranial hypertension to prevent serious complications and irreversible damage.