以人工腦膜修補鼻竇內視鏡手術術中腦脊髓液漏

Intraoperative CSF Leakage Repair Using DuraGen(superscript ®) in FESS

曾文星(Wen-Hsing Tseng) ； 沈炳宏(Ping-Hung Shen) ； 賴仁淙(Jen-Tsung Lai) ； 李祖信(Cho-Shun Li)

《台灣耳鼻喉頭頸外科雜誌》 46卷1期 (2011/02) Pp. 44-47

https://doi.org/10.6286/2011.46.1.44

摘要

源自額竇或篩竇的黏液囊腫，臨床上通常不易發現。因常涉及眼窩與前顱窩，在打開囊腫時可能會發現有因黏液囊腫局部壓迫顱底而導致硬腦膜破裂及腦脊髓液漏的情況。鼻內視鏡修補腦脊髓液漏，以往大多以取自鼻甲、鼻中膈或鼻竇之黏膜修補，但因較費時，時有併發症產生之報告。本院在97年1月經驗一例53歲女性病患，主述咳嗽及雙側鼻濃分泌物多年，有鼻塞、濃痰情形。病患曾於89年因鼻竇炎併鼻息肉進行功能性鼻內視鏡手術。術前3個月的電腦斷層高度懷疑鼻中膈後方黏液囊腫，再次進行功能性鼻內視鏡手術時，發現大部份的鼻竇皆嚴重骨化，因此在完全缺乏解剖地標(Landmark)的情況下，小心將骨化部份鑽磨移除，並發現囊腫已縮小並局限在鼻中膈後上方往後直達顱底。可惜於鑽磨的過程中打開囊腫即見腦脊髓液漏情形以及顱底硬腦膜破裂（約3mm），術中立即以人工合成硬膜替代物(DuraGen 上標 ®)快速修補，術後症狀改善且無併發症發生，目前於門診規律追蹤中。鑒於醫源性腦脊髓液漏發生率隨著內視鏡手術增多而時有所聞，因之如何應用新的生物材質快速修補腦膜破裂以減少併發症是非常重要，特提出此病例報告。

關鍵字

黏液囊腫 ； 腦脊髓液漏 ； 硬腦膜

並列摘要

Mucoceles which originated from the frontal sinus or the ethmoid sinus are not easily detected. We may need to repair the CSF leaks and the dura defect after the removal of the mucocele, especially when they are attached to the orbital or the anterior cranial fossa. Different methods are suggested in clinical literature to repair the CSF leaks, however, postoperative complications can occur if the repair time takes too long. Here is the case of a 56-year-old woman who came to our hospital complained of post nasal dripping with orbital swelling sensation for a long time. She had received a sinus surgery 8 years ago due to chronic sinusitis and polyps. This time CT revealed a large mucocele located in the post ethmoid and post-nasal septum area, then FESS was suggested and performed. During the operation we found that most of the paranasal sinuses were seriously ossified. After drilling out the ossified sinus tissue, we found that the mucocele had confined to the posterior nasal septum and extending to the skull base. Unfortunately, CSF leaks resulted from the defect of the anterior skull base (approximately 3 mm) immediately after removal of the mucocele. The defect was then repaired by a synthetic dural substitute (DuraGen(superscript ®)) with a sandwich manner. The result was excellent. The use of new biomaterials for rapid and safe dural reconstruction is discussed.

並列關鍵字

mucocele ； cerebrospinal fluid leaks ； dura