CAJ | 학술논문

目的探讨神经内镜下修补脑脊液鼻漏及颅底重建的方法和技术要点.方法回顾分析厦门大学附属中山医院神经内镜下脑脊液鼻漏的鞍底和前颅底手术修补26例患者的临床特性、手术治疗特点及随访资料.其中男19例,女7例;平均年龄31.5岁,包括筛窦型6例,蝶窦型14例,混合型6例,无额窦型.结果本组脑脊液鼻漏包括外伤性17例,鞍区术后6例,鼻内镜术后2例,垂体瘤伽马刀术后1例.全部经单鼻孔神经内镜下手术修补治愈,其中1次手术修补成功22例,占84%,2次手术者4例.术后随访时间6个月～4年,平均2年,未出现复发脑脊液鼻漏和新的神经功能缺失.结论神经内镜下脑脊液鼻漏修补成功的关键在于准确定位漏口,牢靠颅底重建和修补材料的固定及术后持续腰池引流的选择应用.经鼻神经内镜下修补脑脊液鼻漏是一个可靠、有效、微创值得推广的手术方法.
목적 탐토신경내경하수보뇌척액비루급로저중건적방법화기술요점.방법 회고분석하문대학부속중산의원신경내경하뇌척액비루적안저화전로저수술수보26례환자적림상특성、수술치료특점급수방자료.기중남19례,녀7례;평균년령31.5세,포괄사두형6례,접두형14례,혼합형6례,무액두형.결과 본조뇌척액비루포괄외상성17례,안구술후6례,비내경술후2례,수체류가마도술후1례.전부경단비공신경내경하수술수보치유,기중1차수술수보성공22례,점84%,2차수술자4례.술후수방시간6개월～4년,평균2년,미출현복발뇌척액비루화신적신경공능결실.결론 신경내경하뇌척액비루수보성공적관건재우준학정위루구,뢰고로저중건화수보재료적고정급술후지속요지인류적선택응용.경비신경내경하수보뇌척액비루시일개가고、유효、미창치득추엄적수술방법.
Objective To explore the methods and techniques of repairing cerebrospinal fluid (CSF) rhinorrhea and reconstructing the defects of skull base under endoscopy. Methods The clinical data of 26 patients undergoing endoscopic repair of CSF rhinorrhea were analyzed retrospectively. There were 19males and 7 females with an average age of 31. 5 years old. Rhinorrhea was classified into 4 types: ethmoidalsinus type (n=6), sphenoid sinus type (n=14) and mixed type (n=6) and frontal sinus type (n=0).Results The causes of rhinorrhea were as follows: traumatic leakage (n=17) , post-operative breakage of saddle area (n=6) , damage after endonasal surgery (n=2) rhinorrhea after γ-knife for pituitary (n=1).All cases were successfully repaired via an endoscopic endonasal approach. Among them, 22 patients were repaired only once while 4 patients with recurrent CSF rhinorrhea were repaired again. The follow-up period was from 6 months to 4 years. And satisfactory outcomes were achieved in all. Conclusion Accurate localization of CSF leakage, reliable reconstruction of skull base, secure fixation of adhesive materials and continuous lumbar CSF drainage are keys surgical techniques. Endoscopic repair of front skull base and saddle bottom of CSF rhinorrhea is a reliable, effective and mini-invasive surgical approach worth further popularization.