Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

經鼻內視鏡腦脊髓液鼻漏修補術

江榮山(Rong-San Jiang) ； 許振益(Chen-Yi Hsu)

《中華民國耳鼻喉科醫學雜誌》 37卷5期 (2002/08) Pp. 330-335

https://doi.org/10.6286/2002.37.5.330

摘要

背景：經鼻內視鏡術在近來已經成為修補腦脊髓液鼻漏常用的方法。和傳統方法比較，它有低罹病率和高成功率的優點。
方法：從1997年4月起，本科開始使用經鼻內視鏡術來修補腦脊髓液鼻漏。在內視鏡下，尋找出硬腦膜破洞後，使用自由瓣來修破洞。在利用纖維素膠來固定自由瓣。自由瓣再進一步用Gelform®一小塊Merocel®來填塞。術後，使用抗生素來避免併發症，但在手術前後並不作腰椎脊髓液引流。
結果：共有11名腦脊髓液鼻漏病患接受經鼻內視鏡修補術治療。腦脊髓液鼻漏的原因於9名病患是外科傷害（功能性內視鏡鼻竇手術），其餘2名病患是頭部外傷。硬腦膜破洞有4名病患位於前篩竇頂，有4名病患位於後篩竇頂，有3名病患位於篩板。1名病患需要2次經鼻內視鏡修補術因為第一次手術失敗。總共施行12次經鼻內視鏡修補術。其中，9次手術屬於立即修補手術，3次手術屬於延遲修補手術。自由瓣的取得有8次是取自中鼻甲，2次是下鼻甲，1次是鼻中膈，1次是篩竇黏膜。有一例手術併發症（腦膜炎）發生。平均追蹤18.9月後，腦脊髓液鼻漏在所有病患均痊癒。
結論：經鼻內視鏡手術是一種修補腦脊髓液鼻漏有效且低罹病率的手術。

關鍵字

腦脊髓液鼻漏 ； 功能性內視鏡鼻竇手術 ； 經鼻內視鏡修補術

並列摘要

BACKGROUND: Transnasal endoscopy has recently become a popular method for repair-ing cerebrospinal fluid (CSF) rhinorrhea. It has the advantage of lower morbidity and a high success rate as compared with traditional methods.
METHODS: Since April 1997. CSF rhinorrhea has been tried to be repaired by using a transnasal endoscopic approach in our department. Under the endoscope, the dural defect was identified and repaired with a free graft. The free graft was secured with fibrin glue. The graft was further packed with Gelform® and a piece of Merocel® After surgery, anti-biotics were administered to prevent complications. However, a lumbar spinal drain was not used perioperatively.
RESULTS: Eleven patients with CSF rhinorrhea have undergone transnasal endoscopic repair. The causes of CSF rhinorrhea was surgical trauma (functional endoscopic sinus surgery) in 9 patients and head injury in another 2 patients. The dural defects were located on the anterior ethmoid roof in 4 patients, on the posterior ethmoid roof in 4 patients, and on the cribriform plate in 3 patients. One patient needed the procedure twice because the first on failed. In total, 12 procedures have been performed. Among them, nine procedures were immediate and 3 were delayed repair. The free graft was harvested from the middle turbinate in 8 procedures, from the inferior turbinate in 2 procedures, from the nasal septum in 1 procedure, and from the ethmoid sinus mucosa in 2 procedures, from the nasal septum in 1 procedure, and from the ethmoid sinus mucosa in 1 procedure. A postoperative complication (meningitis) occurred in 1 procedure. After a mean follow-up of 18.9 months, CSF rhinorrhea was successfully stopped in all patients.
CONCLUSIONS: A transnasal endoscopic approach is an effective procedure with lower morbidiy for repair of CSF rhinorrhea from ethmoid sinus and cribriform plate regions after a mean follow-up of 18.9 months.

並列關鍵字

cerebrospinal fluid rhinorrhea ； functional endoscopic sinus surgery ； transansal endoscopic repair