- 期刊
Endoscopic Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea
經內視鏡手術修復自發性腦脊髓液鼻漏
摘要
腦脊髓液鼻漏常見症狀為持續性的流鼻水、鼻塞、頭痛，若沒有加以治療，可能有發生腦炎、腦膜炎、甚至死亡的危險。腦脊髓液鼻漏可分為原發性（自發性）與次發性；次發性腦脊髓液鼻漏常見，可能為突然間的用力（例如打噴嚏及咳嗽）、頭部外傷、鼻部手術、或是由顱底及顱內的腫瘤引起。然而，自發性腦脊髓液鼻漏則少見，只佔所有腦脊髓液鼻漏個案的3至4%,不易發現，為診斷及治療的挑戰。一般來說，個案經頭部電腦斷層或核磁共振影像學檢查後，會藉由手術方式修復，傳統上是以開顱手術修補腦脊髓液鼻漏部位，但手術費時耗力。本文報告3例自發性腦脊髓液鼻漏的個案，經鼻竇內視鏡修補手術，症狀改善良好；因此，經鼻竇內視鏡修補手術，對於自發性腦脊髓液鼻漏的個案來說，可提供其另一治療方式的選擇。
並列摘要
Spontaneous cerebrospinal fluid (CSF) rhinorrhea is rare. Careful history taking and a low threshold of suspicion are needed in its correct diagnosis. Biochemical analysis of nasal discharge is essential, but clinically it may be difficult to collect sufficient samples for study. It is a general rule to have accurately identified the location of the leak before attempting surgery. Imaging modalities such as computed tomography (CT) and magnetic resonance (MR) cisternography help in localizing the site of the defect. If not treated properly, this seemingly innocent condition can lead to serious complications such as meningitis and even death. As to the surgical repair, there is no universal technique. Traditionally, the solution to this condition has been open repairs via extracranial or intracranial approach. In this article, we report three cases of spontaneous CSF rhinorrhea successfully repaired via endonasal endoscopes. Although spontaneous CSF leaks are most challenging to repair due to identification of their locations, the high success rates in our experience using endonasal endoscopy are encouraging. Otolaryngologists provide an alternative solution to this challenging clinical problem.
延伸閱讀
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