迟发性脑脊液漏合并额颞颅骨缺损的同期手术治疗

目的探讨创伤性迟发性脑脊液鼻漏合并额颞颅骨缺损同期手术治疗的方法与效果。方法回顾性分析16例创伤性迟发性脑脊液鼻漏合并额颞颅骨缺损患者的临床资料。患者均同期行显微镜（12例）或内镜（4例）辅助下脑脊液鼻漏修补和颅骨缺损修补术，采用“三明治”法修补脑脊液漏口，三维成形钛网修补颅骨缺损。结果术后随访患者3个月～15年，平均7.8年。其中15例患者痊愈，术后未再发生脑脊液漏；1例患者术后发生轻微脑脊液鼻漏，经蛛网膜下腔持续引流半个月治愈；均无切口、颅内感染及排异反应发生。结论创伤性迟发性脑脊液鼻漏合并额颞颅骨缺损可以行同期手术治疗；显微镜和内镜辅助有助于发现漏口，对前颅窝底骨折迟发性脑脊液漏采用“三明治”法颅底重建有良好的效果。术前CT准确定位漏口，必要的综合治疗是治疗脑脊液鼻漏的关键。

Abstract： Objectives To explore the method and effect of simultaneous surgical treatment of delayed traumatic cerebrospinal fluid rhinorrhea combined with frontotemporal skull defect. Methods The clinical data of 16 patients with traumatic delayed cerebrospinal fluid rhinorrhea complicated with frontotemporal skull defect were analyzed retrospectively. All patients underwent microscopical(12 cases) or endoscopic(4 cases) assisted repair of cerebrospinal fluid rhinorrhea and skull defect. The “sandwich repair” method was used to repair cerebrospinal fluid leakage, and three-dimensional titanium mesh was used to repair skull defect. Results The patients were followed up for 3 months to 15 years, with an average of 7.8 years. Among them, 15 patients were cured and no cerebrospinal fluid leakage occurred after operation. One patient had slight cerebrospinal fluid rhinorrhea after operation, which was cured by continuous drainage through subarachnoid space for half a month. No incision, intracranial infection and rejection occurred. Conclusions Traumatic delayed cerebrospinal fluid rhinorrhea combined with frontotemporal skull defect can be treated at the same time. Microscope and endoscope are helpful to find the leakage, and the “sandwich repair” method is effective for skull base reconstruction of delayed cerebrospinal fluid leakage of anterior cranial fossa fracture. Accurate location of the leak by CT before operation and necessary comprehensive treatment are the key to the treatment of cerebrospinal fluid rhinorrhea.