聽神經瘤術後腦脊髓液鼻漏－病例報告

腦脊髓液外洩是聽神經瘤手術併發症中最常見的，發生率約為10%至21%，此併發症約有6%的可能會導致腦膜炎，故需積極處理。病人為35歲女性，發現左側漸進性聽障及耳鳴有5年，純音聽力檢查顯示患者聽力良好，但左側高頻部位有不對稱的聽力喪失。ABR檢查結果，左側兩耳間第V波潛值差為0.44 msec，I到V波潛時間隔差為4.2 msec。經MRI發現有內聽道及道外直徑約0.8cm的腫瘤而接受經迷路摘除手術並以脂肪填塞術腔。病理報告為聽神經瘤。術後3週即發現頭向前傾時鼻腔會流出清水般液體，病人經過臥床休息、傷口緊密縫合及腰椎穿刺引流降壓等保守療法均無效。改採手術重新填塞也無效。最後將傷口打開探查時，發現上次手術所填塞的脂肪並未移位或被吸收，仍位在乳突竇及術腔之內。我們採取耳咽管填塞並封閉外耳道手術，外洩方止。術後追蹤至今10個月，情況良好，沒有再發生腦脊髓液鼻漏的情形。

關鍵字

聽神經瘤；腦脊髓液外洩

並列摘要

Cerebrospinal fluid (CSF) leak, with an incidence of 10% to 21%, is the most common complication following acoustic neuroma surgery. Six percent of these cases may lead to meningitis which has significant morbidity and even mortality. In this paper, we reported a 35-year-old woman who had suffered from progressive hearing impairment and tinnitus of the left ear for 5 years when she presented. Pure tone audiometry revealed asymmetric sensorineural hearing loss at high tone frequency. IPL (I-V) and ILD (V) of auditory brainstem response were 4.2 msec and 0.44 msec respectively. Magnetic resonance imaging revealed a 1.2×0.8 cm acoustic neuroma extending from interal auditory canal to cerebellopontine angle. She received translabyrinthine resection of the tumor. Approximately 3 weeks after the operation, cerebrospinal fluid rhinorrhea was noted. Persistent CSF leak occurred after conservative treatment including bed rest, pressure dressing and wound suture. She underwent revision mastoid cavity obliteration. However, the revision surgery failed. Finally, more extensive interventions including removing tympanic membrane and ossicles, sacrifying the mucosa from the middle ear, plugging the eustachian tube and closing the external auditory canal was adopted. After this procedure, there was no further evidence of CSF rhinorrhea.

並列關鍵字

acoustic neuroma ； cerebrospinal fluid leak

國際替代計量

聽神經瘤術後腦脊髓液鼻漏－病例報告

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