摘要：

目的: 探讨自发性蝶窦外侧隐窝脑脊液鼻漏的临床特点、诊断及手术治疗。方法与结果: 回顾分析2019年1月至2023年6月首都医科大学附属北京同仁医院收治的24例自发性蝶窦外侧隐窝脑脊液鼻漏患者的临床资料。男性7例、女性17例，平均年龄为46岁，平均体重指数为27.24 kg/m²；21例术前腰椎穿刺脑脊液压力平均为200 mm H₂O，其中11例≥ 200 mm H₂O；影像学检查均存在骨质缺损以及脑膜脑膨出疝入蝶窦内。所有患者均行经鼻内镜脑脊液鼻漏修补术，其中2例术前脑脊液压力≥ 300 mm H₂O，先行腰大池-腹腔分流术；余22例先行内镜下经翼突入路蝶窦外侧隐窝脑膜脑膨出切除术伴颅底漏口修补术。术后2周21例复查脑脊液压力为140~320 mm H₂O，平均185 mm H₂O；平均随访25.40个月，3例脑脊液鼻漏复发，行腰大池-腹腔分流术，最终所有患者均实现临床治愈。结论: 自发性脑脊液鼻漏多与慢性颅内压增高有关，经鼻内镜漏口修补及分流手术是治愈并防止复发的有效方法。

关键词: 脑脊液鼻漏, 蝶窦, 神经内窥镜, 颅内高压, 脑脊髓液分流术

Abstract:

Objective: To investigate the clinical features, diagnosis and surgical treatment of spontaneous cerebrospinal fluid rhinorrhea (CSFR) in the lateral recess of sphenoid sinus. Methods and Results: A retrospective analysis was conducted on the clinical data of 24 patients with spontaneous CSFR in the lateral recess of sphenoid sinus admitted to Beijing Tongren Hospital, Capital Medical University, between January 2019 and June 2023. Among them, there were 7 males and 17 females, with an average age of 46 years and an average body mass index (BMI) of 27.24 kg/m². The average preoperative lumbar puncture (LP) cerebrospinal fluid (CSF) pressure was 200 mm H₂O in 21 patients, with 11 patients exhibiting CSF pressure ≥ 200 mm H₂O. Imaging studies revealed bone defects and meningoencephalocele herniation into the sphenoid sinus in all 24 patients. All patients underwent transnasal endoscopic repair surgery for CSFR. Specifically, 2 patients with preoperative CSF pressure ≥ 300 mm H₂O underwent lumboperitoneal shunt (LPS) first, while the remaining 22 patients underwent endoscopic resection of meningoencephalocele in the lateral recess of sphenoid sinus via the pterygoid process approach, accompanied by skull base leak repair surgery. Two weeks postoperatively, the CSF pressure was reviewed in 21 patients, ranging from 140 to 320 mm H₂O, with an average of 185 mm H₂O. All patients were followed up for an average duration of 25.40 months. Subsequently, 3 patients with recurrent CSFR underwent LPS, and all 24 patients achieved clinical cure. Conclusions: Spontaneous CSFR is related to chronic intracranial hypertension. Transnasal endoscopic leakage repair and CSF shunts are effective methods to treat this disease and prevent recurrence.

Key words: Cerebrospinal fluid rhinorrhea, Sphenoid sinus, Neuroendoscopes, Intracranial hypertension, Cerebrospinal fluid shunts