Middle Cranial Fossa (MCF) Approach Without the Use of Lumbar Drain for the Management of Spontaneous Cerebral Spinal Fluid (CSF) Leaks
Middle Cranial Fossa (MCF) Approach Without the Use of Lumbar Drain for the Management of Spontaneous Cerebral Spinal Fluid (CSF) Leaks
复制标题
DOI：
10.1097/mao.0000000000001208
复制
发表时间：
2016-12-01
影响因子：
2.1
通讯作者：
Hansen, Marlan R.
中科院分区：
文献类型：
--
作者：
Nelson, Rick F.;Roche, Joseph P.;Hansen, Marlan R.
目的：由于自发性脑脊液漏在围手术期的应用仍存在争议，因此采用中颅窝(MCF)入路修补自发性脑脊液漏(CSF)的疗效和发病率仍存在争议。研究设计：2003-2015年间的回顾性研究。地点：爱荷华大学医院和诊所及印第安纳大学卫生中心。患者：确诊为侧颅底自发性脑脊液漏和/或脑膨出的患者。干预：经MCF入路修补自发性脑脊液漏和/或脑膨出，不使用腰椎引流管。评估患者的年龄、性别、体重指数(BMI)和内科合并症。主要结果测量：收集自发性脑脊液漏患者的特征(年龄、性别、BMI、阻塞性睡眠呼吸暂停)。统计住院时间、住院费用、术后并发症、脑脊液漏发生率、是否需要腰椎管引流。结果：60例自发性脑脊液漏患者中，5例为双侧脑脊液漏，均行手术修补。60例患者中有15例使用了LD脑脊液分流术，大多在2010年前。2010年后，44名患者中只有3名(6.7%)术后耳漏需要LD。使用LD显著延长了LOS(3.6+/-1.6天比8.7+/-2.9天)和住院费用(29,621美元)。77%(50/65)的病例无术后并发症。3例因额部硬膜下血肿(1例)、硬膜下脑脊液积液(1例)、张力性气头(1例)等并发症需返回手术室。无一例出现长期神经后遗症或脑脊液漏复发，平均随访19.5个月(3~137个月)。患者平均体重指数为37.5±8.6 kg/m(2)。平均年龄为57.5+/-11.4岁，女性占68%。阻塞性睡眠呼吸暂停发生率为43.3%(26/60)。结论：MCF开颅修补自发性脑脊液漏的发生率低，远期疗效高。围手术期普遍使用腰椎管引流并没有指征，并且显著增加了住院时间和住院费用。肥胖和阻塞性睡眠呼吸暂停与自发性脑脊液漏高度相关。
Objective: To determine the efficacy and morbidity of repairing spontaneous cerebrospinal fluid (CSF) leaks with the middle cranial fossa (MCF) approach without the use of a lumbar drain (LD), as perioperative use of LD remains controversial.Study Design: Retrospective review from 2003 to 2015.Setting: University of Iowa Hospitals and Clinics and Indiana University Health Center.Patients: Those with a confirmed lateral skull base spontaneous CSF leaks and/or encephaloceles.Intervention: MCF approach for repair of spontaneous CSF leak and/or encephalocele without the use of lumbar drain. Assessment of patient age, sex, body mass index (BMI), and medical comorbidities.Main Outcome Measure: Spontaneous CSF leak patient characteristics (age, sex, BMI, obstructive sleep apnea) were collected. Length of stay (LOS), hospital costs, postoperative complications, CSF leak rate, and need for LD were calculated.Results: Sixty-five operative MCF repairs were performed for spontaneous CSF leaks on 60 patients (five had bilateral CSF leaks). CSF diversion with LD was used in 15 of 60 patients, mostly before 2010. After 2010, only three of 44 patients (6.7%) had postoperative otorrhea requiring LD. The use of LD resulted in significantly longer LOS (3.6 +/- 1.6 versus 8.7 +/- 2.9 d) and hospital costs ($29,621). There were no postoperative complications in 77% (50 of 65) of cases. Three cases required return to the operating room for complications including frontal subdural hematoma (1), subdural CSF collection (1), and tension pneumocephalus (1). No patients experienced long-term neurologic sequelae or long-term CSF leak recurrence with an average length of follow-up of 19.5 months (range 3-137 mo). The average patient BMI was 37.5 +/- 8.6 kg/m(2). The average age was 57.5 +/- 11.4 years and 68% were female. Obstructive sleep apnea was present in 43.3% (26 of 60) of patients.Conclusion: The morbidity of the MCF craniotomy for repair of spontaneous CSF leaks is low and the long-term efficacy of repair is high. Universal use of perioperative lumbar drain is not indicated and significantly increases length of stay and hospital costs. Obesity and obstructive sleep apnea are highly associated with spontaneous CSF leaks.