脑脊液鼻漏的经颅外科手术治疗
DOI:
作者:
作者单位:

作者简介:

陈云祥(1969-),男,医学硕士,副主任医师.主要从事颅脑损伤、神经系统肿瘤的基础和临床研究.

通信作者:

基金项目:

江苏省科教兴卫工程医学重点学科(No.XK201117)


Transcranial surgery for repair of cerebrospinal fluid rhinorrhea
Author:
Affiliation:

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 音频文件
  • |
  • 视频文件
    摘要:

    目的 探讨经颅手术修补脑脊液鼻漏的手术指征和手术方法.方法 我科2011年3月至2013年5月共7例经保守治疗无效的脑脊液鼻漏患者,经颅手术治疗.术前测定鼻腔渗液的含糖量和鼻内镜检查确诊,多排头颅CT薄层扫描,并行二维冠状位重建确认漏口位置.手术均取额部冠状切口.修补在硬膜外和硬膜下两个层面进行,还纳嵌顿疝出的脑组织,骨蜡或骨水泥修补颅骨缺损,脂肪填塞硬脑膜漏口,自体筋膜和人工硬脑膜修补硬脑膜缺损,生物蛋白胶加强固定.术后抗感染、支持治疗.结果 7例患者效果均满意,1例患者术后3周左右再次出现少量脑脊液鼻漏,经保守治疗后痊愈.随访1年以上均未见复发.结论 多排头颅CT薄层扫描、并行二维冠状位重建对确认漏口位置有重要指导意义.通过对颅骨和硬脑膜两个层面进行手术修补,能有效修补漏口,取得满意疗效.

    Abstract:

    Objective To investigate the surgical indications and strategy for transcranial surgery for repair of cerebrospinal fluid rhinorrhea.Methods From March 2011 to May 2013, seven patients with cerebrospinal fluid rhinorrhea who were unresponsive to conservative therapy underwent a transcranial surgical repair in our hospital. The sugar content of leaking cerebrospinal fluid was measured and nasal endoscopy was performed to confirm the cerebrospinal fluid leakage. Thin multislice head CT scan and parallel two-dimensional coronal reconstruction were used to confirm the position of leak port. Forehead coronal incision was applied in all patients. Patching for leak ports was performed in both the epidural space and the subdural space, and the incarcerated brain hernia was cleared. Bone wax or bone cement was used to repair the skull defects. Fat patches were used to pack the leak port in the dura mater, and autologous fascia and artificial dura were used to repair the dural defects. Biological fibrin glue was used to strengthen the fixing material. Treatment for postoperative infection and supportive therapy were given to all the patients.Results Satisfactory results were achieved in all seven patients. One patient had a small amount of cerebrospinal fluid leakage about three weeks after the surgery, but was cured by conservative treatment. No recurrence of cerebrospinal fluid leakage was observed in the follow-up longer than 1 year.Conclusions Thin multislice head CT scan and parallel two-dimensional coronal reconstruction play significant roles in confirming the position of leak port. Surgical repairs in both the skull and the dura mater effectively patch the leak ports and produce satisfactory results.

    参考文献
    相似文献
    引证文献
引用本文

陶超, 徐佳, 程刚, 耿晓增, 陈云祥456.脑脊液鼻漏的经颅外科手术治疗[J].国际神经病学神经外科学杂志,2014,41(5):401-403111TAO Chao, XU Jia, CHENG Gang, GENG Xiao-Zeng, CHEN Yun-Xiang222. Transcranial surgery for repair of cerebrospinal fluid rhinorrhea[J]. Journal of International Neurology and Neurosurgery,2014,41(5):401-403

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2014-06-24
  • 最后修改日期:2014-09-28
  • 录用日期:
  • 在线发布日期: 2014-10-28
关闭
我刊在喜马拉雅FM开通账号并传播文献

关闭