Outcome of Endoscopic Cerebrospinal Fluid Rhinorrhoea Repair: An Institutional Study
Outcome of Endoscopic Cerebrospinal Fluid Rhinorrhoea Repair: An Institutional Study
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DOI：
10.1007/s12070-018-1485-2
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发表时间：
2019-03-01
影响因子：
0.6
通讯作者：
Sharma, Akriti
中科院分区：
文献类型：
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作者：
Majhi, Sudhir;Sharma, Akriti
脑脊液鼻溢症是由蛛网膜下腔和鼻腔之间异常开放的交通引起的。最常见的解剖部位是前颅底，即筛顶、嗅沟、蝶窦顶和额窦后壁。它可以分为创伤性和自发性。自发性漏与手术修复后最高的复发率有关。脑脊液鼻溢症的修复在过去30年中迅速演变。在内窥镜方法出现之前，开颅手术用于修复，其成功率和发病率各不相同。我们研究的目的是确定经鼻内窥镜修复自发性脑脊液漏的结果。这是一项在2015年1月至2016年6月期间在新德里Safdarjung医院耳鼻喉科进行的前瞻性研究。这项研究包括11名患者，他们以流鼻水为主诉，并被诊断为自发性脑脊液鼻溢症。对患者的鼻腔分泌物进行了适当的临床检查、鼻内窥镜检查和生化及细胞学分析。对鼻腔和副鼻窦进行高分辨率CT和MRI扫描，以确定脑脊液漏的准确位置和瘘管的大小。CT脑池造影术在需要的地方进行。瘘口经鼻内窥镜下多层衬垫修补。在11例自发性脑脊液漏中，最常见的漏部位是左侧筛状区。脑膜脑膨出4例(36.36%)。未发现相关的颅内病变，所有患者均无任何良性颅内高压。本组一次内窥镜修复成功率为100%，1例修复4个月后复发。鼻内窥镜下脑脊液鼻漏修补术安全有效，并发症发生率极低。它几乎完全取代了旧的开放技术。准确定位渗漏部位，然后多层封闭硬脑膜缺损似乎是成功的内窥镜修复的关键。
Cerebrospinal fluid Rhinorrhoea is caused by an abnormal open communication between the subarachnoid space and the nasal cavity. The most common anatomic sites of such abnormal communication are found in the anterior skull base, namely, ethmoid roof, olfactory groove, roof of the sphenoid sinus and the posterior wall of the frontal sinus. It can be classified into traumatic or spontaneous. Spontaneous leaks are associated with highest recurrence rates following surgical repair. The repair of CSF Rhinorrhoea has rapidly evolved over the past 30years. Prior to the advent of the endoscopic approach, craniotomy was used for repairs which carried a variable success rate and morbidity. The purpose of our study was to ascertain the outcome after Transnasal Endoscopic Repair of spontaneous CSF leaks. This was a prospective study conducted at the Department of ENT at Safdarjung Hospital, New Delhi between January 2015 and June 2016. The study comprised of eleven patients who presented with the complaint of watery nasal discharge and were diagnosed to have spontaneous CSF Rhinorrhoea. Proper clinical examination, nasal endoscopy and biochemical and cytological analysis of nasal secretions of the patient was done. High Resolution Computed Tomography and MRI scans of the nose and paranasal sinuses were done to identify precise location of CSF leak and the size of fistula. CT cisternography was done wherever required. Fistula was repaired via Transnasal endoscopic approach in a multi layered underlay fashion. Out of all eleven patients with spontaneous CSF leaks, most common site of leak was from left cribriform area. Four patients (36.36%) were found to have meningoencephalocele. No associated intracranial lesion was found and all patients did not have any benign intracranial hypertension. Our success rate of endoscopic repair on first attempt was 100% with recurrence in 1 patient after 4months of repair. Endoscopic repair of CSF rhinorrhoea is safe and effective, with a very low complication rate. It has almost completely replaced the older open techniques. Accurate localization of leak site followed by multilayered closure of dural defect appear to be essential for successful endoscopic repair.