摘要：

目的 总结经鼻内镜手术治疗脑脊液鼻漏的临床经验。方法 2011 年 4 月至 2018 年 8 月采用经鼻内镜手术共治疗 24 例脑脊液鼻漏患者，医原性 11 例（45.83%），包括经颅显微颅咽管瘤切除术（6 例）、经鼻内镜垂体瘤切除术后（4 例）和经鼻内镜视神经管减压术后（1 例）；外伤性 10 例（41.67%），自发性 3 例（12.50%）。术前经 CT 和 MRI 平扫、CT 脑池造影和 MR 水成像检查定位漏口，行经鼻内镜脑脊液鼻漏修补术。结果 经内镜探查 24 例患者共发现 27 个漏口，其中，医原性 14 个、外伤性 10 个、自发性 3 个，分别采用游离黏膜瓣、带蒂黏膜瓣、肌肉组织、脂肪组织、阔筋膜和人工硬膜等材料，经单侧或双侧筛窦、经鼻中隔旁经蝶窦或经泪前隐窝经翼突入路封堵漏口。首次手术成功率为 91.67%（22/24），再次手术成功率 8.33%（2/24），总成功率为 100%。术后 2 例（8.33%）并发脑膜炎，经鞘内注射抗生素和腰大池引流术治愈。平均随访 20 个月，无复发病例。结论 经鼻内镜手术是治疗脑脊液鼻漏的有效方法，具有定位准确、创伤小、术后并发症少等优点，术后腰椎穿刺和腰大池引流术有助于提高疗效。

关键词: 脑脊液鼻漏, 内窥镜, 神经外科手术, 体层摄影术, X 线计算机, 磁共振成像

Abstract:

Objective To summarize clinical experience of endoscopic transnasal surgery for treatment of cerebrospinal fluid (CSF) rhinorrhea. Methods From April 2011 to August 2018, 24 cases of CSF rhinorrhea patients were treated by endoscopic transnasal surgery. There were 11 (45.83%) iatrogenic injuries caused by transcranial microsurgical resection of craniopharyngioma (6 cases), endoscopic transnasal surgery for resection of pituitary adenoma (4 cases), or endoscopic transnasal surgery for optic canal decompression (one case). There were also 10 cases (41.67%) of traumatic and 3 cases (12.50%) of spontaneous CSF rhinorrhea. The leaks were located by preoperative CT, MRI, CT cisternography and MR hydrography. Endoscopic transnasal surgery for CSF rhinorrhea repair was performed. Results A total of 27 leaks were found by endoscopy in 24 cases, including 14 iatrogenic, 10 traumatic and 3 spontaneous. They were repaired by materials such as dissociated mucosal flaps, pedicled mucosal flaps, muscle tissue, fat tissue, fascia lata or artificial dura mater via unilateral or bilateral transethmoid, transnaso-sphenoidal or transnasal prelacrimal recess-pterygoid approaches. The success rate of the first operation was 91.67% (22/24), and the success rate of the second operation was 8.33% (2/24), therefore the total success rate was 100%. Two patients (8.33%) suffered from postoperative meningitis, and were cured by intrathecal injection of antibiotics and lumbar cistern drainage. All patients were followed-up for average 20 months, and no one relapsed. Conclusions Endoscopic transnasal approach is an effective technique for treating CSF rhinorrhea. It has the advantages of accurate location, small trauma, less postoperative complications and so on. Lumbar puncture or lumbar cistern drainage helps to improve the effect of surgery. 

Key words: Cerebrospinal fluid rhinorrhea, Endoscopes, Neurosurgical procedures, Tomography, X-ray computed, Magnetic resonance imaging