Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks
Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks
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DOI：
10.1055/s-0037-1617439
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发表时间：
2018-10-01
影响因子：
0.9
通讯作者：
Smouha, Eric
中科院分区：
文献类型：
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作者：
Perez, Enrique;Carlton, Daniel;Smouha, Eric
目的 确定单纯经乳突入路修复自发性脑脊液（CSF）漏的疗效，并进一步阐明患者群体中体重指数（BMI）升高与颅底厚度的关系。方法对 2006 年至 2015 年在我院三级医疗机构接受自发性颞骨脑脊液漏治疗的患者进行回顾性图表回顾。病例分为原发性或继发性。我们分析了成功率、住院时间、腰椎引流管的使用、体重指数和脑膜炎发生率。将每个病例的颅底厚度与 BMI 进行比较。结果 我们确定了 26 例自发性脑脊液漏初次手术和 7 例二次手术。 33 例修复中有 23 例仅通过经乳突入路进行，成功率为 87% (20/23)。在包括中颅窝 (MCF) 或 MCF-经乳突联合入路在内的 10 例修复手术中，有 2 例失败，成功率为 80% (8/10)。 5 例经乳突修复术接受了腰椎引流术，而所有 10 例修复术均采用颅内暴露。接受经乳突入路患者的平均住院时间（1.7 天）明显短于接受 MCF 修复术的患者（6.3 天）。四名患者出现脑膜炎。平均BMI为35.3。 BMI 和颅底厚度之间没有建立相关性（R-2 = 0.00011）。 结论 经乳突入路在大多数病例中是有效的，并且无需进行颅内手术，从而降低了发病率并缩短了住院时间。我们相信，这是大多数自发性脑脊液漏患者的首选主要方法。
Objective Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population.Method We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case.Results We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the 10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness (R-2 = 0.00011).Conclusion The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.