- 期刊
Traumatic Sphenoid Sinus Fracture Complicated with Cerebrospinal Fluid Leakage and Pneumocephalus-Case Report
創傷性蝶竇破裂併發腦脊髓液滲漏及氣腦－病例報告
摘要
The incidence of post-traumatic cerebrospinal fluid (CSF) leakage after blunt head injury ranges from 2% to 4%. About 80% of leaks occur within 48 hours after the injury, and 95% manifest in 3 months. Conservative measures are effective in approximately 60%-70% patients with traumatic CSF leaks. However, if leaks persist, surgical intervention is needed. Here, we have presented our experience with a case of traumatic sphenoid sinus fracture complicated by CSF leakage and pneumocephalus. The patient was managed conservatively by a neurosurgeon, but CSF leakage persisted. Therefore, transnasal endoscopic repair was performed 8 days after the trauma. After enlarging the left sphenoid sinus natural ostium, a small defect was identified at the posterior wall of the left sphenoid sinus. Bone chips and the surrounding detached mucoperiosteum were removed, and the basilar artery was visible through the defect. The bath-plug technique using the fat tissue obtained from the abdomen was applied to repair the defect. Then, a free mucosal graft harvested from the left nasal septum was used to cover the fat plug and defect area. A TISSEEL fibrin sealant was used. The left sphenoid sinus cavity was packed with Gelfoam®. The patient recovered well after surgery. There was no recurrence of CSF leakage thereafter.
並列摘要
創傷後發生腦脊髓液滲漏，約佔頭部鈍傷2%到4%，80%的腦脊髓液滲漏發生在受傷後的48小時內，95%會發生在受傷後的前3個月。多數病患以鼻漏表現，其他的症狀包括耳漏、氣腦（pneumocephalus）及腦膜炎等。6至7成創傷性腦脊髓液滲漏可採取保守治療，若持續滲漏則需考慮積極手術。1名46歲男性，行走在路上被機車擦撞而送入本院急診，病患生命徵象穩定，有頭痛及鼻漏的症狀，腦部電腦斷層顯示氣腦症及蝶竇後壁破裂，內視鏡檢查發現左側後方蝶竇開口疑似腦脊髓液鼻漏，由神經外科收住院先行保守治療。8天後鼻漏症狀未改善，故安排內視鏡腦脊髓液鼻漏修補手術。術中擴大左側蝶竇自然開口，可見到後壁破裂，移除移位之骨頭及周圍黏膜後，可見基底動脈。取腹部脂肪，使用浴塞（bath-plug）修補方式，再取鼻中隔黏膜覆蓋，及組織修復凝合劑密封，最後以可吸收式填塞物加壓。術後復原情形良好，無腦脊髓液鼻漏之現象。
延伸閱讀
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