山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (1): 28-32.doi: 10.6040/j.issn.1673-3770.1.2019.051

• 临床研究 • 上一篇    下一篇

颞骨外伤并发脑脊液漏18例并文献复习

高娟娟,李欣,许嘉,陈雯婧,梁思超,郭振平,卢曼林,伊海金*()   

  1. 清华大学附属北京清华长庚医院/清华大学临床医学院 耳鼻咽喉头颈外科, 北京 102218
  • 收稿日期:2019-08-27 出版日期:2020-01-20 发布日期:2020-03-06
  • 通讯作者: 伊海金 E-mail:dl7599@163.com

Temporal bone trauma complicated with cerebrospinal fluid leakage: a case series and literature review

Juanjuan GAO,Xin LI,Jia XU,Wenjing CHEN,Sichao LIANG,Zhenping GUO,Manlin LU,Haijin YI*()   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2019-08-27 Online:2020-01-20 Published:2020-03-06
  • Contact: Haijin YI E-mail:dl7599@163.com

摘要: 目的

分析颞骨外伤并发脑脊液漏的临床特点,探讨其诊断及治疗策略。

方法

回顾性分析18例颞骨外伤并发脑脊液漏患者临床表现、辅助检查结果、手术方式、术中探查结果及预后。

结果

17例颞骨外伤并发脑脊液漏患者均一次手术成功,随访期间脑脊液漏未再复发;另外1例患者脑脊液漏第一次术后1年复发,行二次手术,随访至今未复发。所有患者均无术后感染发生。

结论

对于保守治疗效果不佳的颞骨外伤并发脑脊液漏患者,手术探查修补是最为有效的治疗方法,经乳突入路或经迷路入路脑脊液漏探查修补术均取得良好的手术效果;术前的病史、临床表现、实验室检查、影像学分析对于脑脊液漏的诊断、瘘口定位及具体手术方式的选择非常重要。围手术期抗生素预防感染及酌情使用药物控制颅压,均有助于术后恢复。

关键词: 颞骨外伤, 脑脊液漏, 诊断

Abstract: Objective

This study aimed to analyze the clinical characteristics of temporal bonetrauma complicated with cerebrospinal fluid (CSF) leakage and to discuss its diagnosis and appropriate management.

Methods

Eighteen patients with temporal bone trauma complicated with CSF were analyzed retrospectively.

Results

During follow-up, no CSF recurred after the operation except for in one patient. In this, the CSF recurred, a second operation was performed, and the CSF leakage ceased. No postoperative infection occurred in any patient.

Conclusion

Surgical exploration and repair is the most effective method for those who have poor outcomes with conservative treatment of the temporal bone trauma. Medical history, clinical manifestations, laboratory examination and imaging analyses are all essential for diagnosing CSF leakage, locating the CSF, and selecting an appropriate surgical method. Perioperative antibiotics to prevent infection and appropriate drugs to control cranial pressure can improve postoperative recovery.

Key words: Temporal bone trauma, Cerebrospinal fluid leakage, Diagnosis

中图分类号: 

  • R764.21

图1

颞骨HRCT(冠状位)提示右侧鼓室天盖处骨质不连续"

图2

颞骨MRI 3D-FIESTA序列(冠状位)提示右侧鼓室天盖处长T2信号影"

图3

CT脑池造影(冠状位)提示乳突天盖骨质不连续"

图4

颞骨HRCT(水平位)提示右侧内耳IP-Ⅲ型畸形,内耳道底缺损并与耳蜗底转相通"

图5

颞骨HRCT(冠状位)提示右侧内耳道底缺损并与耳蜗底转相通"

1 Dahiya R , Keller JD , Litofsky NS , et al. Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations[J]. J Trauma, 1999, 47 (6): 1079- 1083.
doi: 10.1097/00005373-199912000-00014
2 Exadaktylos AK , Sclabas GM , Nuyens M , et al. The clinical correlation of temporal bone fractures and spiral computed tomographic scan: a prospective and consecutive study at a level Ⅰ trauma center[J]. J Trauma, 2003, 55 (4): 704- 706.
doi: 10.1097/01.TA.0000038550.11890.A5
3 Alvi A , Bereliani A 4th . Trauma to the temporal bone: diagnosis and management of complications[J]. J Craniomaxillofac Trauma, 1996, 2 (3): 36- 48.
4 Ishman SL , Friedland DR . Temporal bone fractures: traditional classification and clinical relevance[J]. Laryngoscope, 2004, 114 (10): 1734- 1741.
doi: 10.1097/00005537-200410000-00011
5 Ghorayeb BY , Yeakley JW . Temporal bone fractures: longitudinal or oblique? The case for oblique temporal bone fractures[J]. Laryngoscope, 1992, 102 (2): 129- 134.
doi: 10.1288/00005537-199202000-00005
6 Nosan DK , Benecke JE Jr , Murr AH . Current perspective on temporal bone trauma[J]. Otolaryngol Head Neck Surg, 1997, 117 (1): 67- 71.
doi: 10.1016/s0194-5998(97)70209-2
7 Brodie HA , Thompson TC . Management of complications from 820 temporal bone fractures[J]. Am J Otol, 1997, 18 (2): 188- 197.
8 MacGee EE , Cauthen JC , Brackett CE . Meningitis following acute traumatic cerebrospinal fluid fistula[J]. J Neurosurg, 1970, 33 (3): 312- 316.
doi: 10.3171/jns.1970.33.3.0312
9 Appelbaum E . Meningitis following trauma to the head and face[J]. JAMA, 1960, 173: 1818- 1822.
doi: 10.1001/jama.1960.03020340036010
10 Kaufman BA , Tunkel AR , Pryor JC , et al. Meningitis in the neurosurgical patient[J]. Infect Dis Clin North Am, 1990, 4 (4): 677- 701.
11 Travis LW , Stalnaker RL , Melvin JW . Impact trauma of the human temporal bone[J]. J Trauma, 1977, 17 (10): 761- 766.
doi: 10.1097/00005373-197710000-00003
12 Yoganandan N , Pintar FA , Sances A Jr , et al. Biomechanics of skull fracture[J]. J Neurotrauma, 1995, 12 (4): 659- 668.
doi: 10.1089/neu.1995.12.659
13 Abrunhosa J , GonÇalves P , dos Santos JG , et al. Traumatic porencephalic cyst and cholesteatoma of the ear[J]. J Laryngol Otol, 2000, 114 (11): 864- 866.
doi: 10.1258/0022215001904185
14 王玥, 刘芊, 王海波. 自发性脑脊液耳漏的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33 (2): 130- 135, 142.
doi: 10.6040/j.issn.1673-3770.0.2018.431
WANG Yue , LIU Qian , WANG Haibo . Prospect and progress of spontaneous cerebrospinal fluid otorrhea[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33 (2): 130- 135, 142.
doi: 10.6040/j.issn.1673-3770.0.2018.431
15 McCudden CR , Senior BA , Hainsworth S , et al. Evaluation of high resolution gel β2-transferrin for detection of cerebrospinal fluid leak[J]. Clin Chem Lab Med, 2013, 51 (2)
doi: 10.1515/cclm-2012-0408
16 Sampaio MH , de Barros-Mazon S , Sakano E , et al. Predictability of quantification of beta-trace protein for diagnosis of cerebrospinal fluid leak: cutoff determination in nasal fluids with two control groups[J]. Am J Rhinol Allergy, 2009, 23 (6): 585- 590.
doi: 10.2500/ajra.2009.23.3409
17 Felgenhauer K , Schädlich HJ , Nekic M . Beta trace-protein as marker for cerebrospinal fluid fistula[J]. Klin Wochenschr, 1987, 65 (16): 764- 768.
doi: 10.1007/bf01743251
18 Kennedy TA , Avey GD , Gentry LR . Imaging of Temporal Bone Trauma[J]. Neuroimaging Clin N Am, 2014, 24 (3): 467- 486.
doi: 10.1016/j.nic.2014.03.003
19 Schubl SD , Klein TR , Robitsek RJ , et al. Temporal bone fracture: Evaluation in the era of modern computed tomography[J]. Injury, 2016, 47 (9): 1893- 1897.
doi: 10.1016/j.injury.2016.06.026
20 Stone JA , Castillo M , Neelon B , et al. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography[J]. AJNR Am J Neuroradiol, 1999, 20 (4): 706- 712.
21 Lewin W . Cerebrospinal fluid rhinorrhea in nonmissile head injuries[J]. Clin Neurosurg, 1964, 12: 237- 252.
doi: 10.1093/neurosurgery/12.cn_suppl_1.237
[1] 许嘉, 伊海金. 正确处理颞骨骨折耳科并发症[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 4-8.
[2] 李华斌, 曹玉洁. 儿童鼻窦炎的临床诊疗进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 16-19.
[3] 许庚. 儿童慢性鼻窦炎的常规诊断不宜使用CT扫描[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 8-9.
[4] 陈太生, 王巍, 徐开旭, 林鹏. 良性阵发性位置性眩晕及其诊断治疗的思考[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 1-5.
[5] 梁程程,王欣,雷大鹏. 电子鼻咽喉镜诊治27400例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 107-110.
[6] 闫志刚,张慧慧,于丹,刘岩,文连姬,王迪. 成人阻塞性睡眠呼吸暂停综合征患者认知功能障碍的诊断及治疗研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 155-161.
[7] 李晓璐. 前庭性偏头痛与几种常见周围性眩晕的鉴别诊断[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 23-26.
[8] 张佳程,张立庆,周涵,陆美萍,许万云,沈宇杰,刘雅琴,殷敏,董伟达. 鼻腔鼻窦恶性黑色素瘤23例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 95-99.
[9] 冯剑,周涵,董伟达. 喉癌内镜诊断技术研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 129-133.
[10] 王玥,刘芊,王海波. 自发性脑脊液耳漏的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 130-135.
[11] 刘传合. 我国儿童哮喘患病与诊治现状[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 28-32.
[12] 关凯,王良录. 从花粉症看过敏性疾病的整体诊疗策略[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 13-19.
[13] 张静祎,王文一,张庆泉. 原发于结膜的黏膜相关淋巴组织淋巴瘤一例报告[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 121-122.
[14] 陈立晓,蒋锐,於子卫. 窄带成像技术在咽喉肿瘤诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 104-108.
[15] 朱明娟,邢凯,亢泽峰,刘健. 甲状腺相关性眼病的诊断及治疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 110-113.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 林彬,王挥戈 . 功能性内镜鼻窦手术后鼻黏膜纤毛转归的研究[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 481 -487 .
[2] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[3] 邓基波,孙奉乾,许安廷 . 大前庭导水管综合征[J]. 山东大学耳鼻喉眼学报, 2006, 20(2): 116 -118 .
[4] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[5] 金向阳,林 海 . 侵袭型曲菌性鼻窦炎侵犯右眼眶、双乳突及左肺1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 259 -259 .
[6] 周子宁,金国威 . 喉气管狭窄的预防和治疗进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 462 -465 .
[7] 公 蕾,孙 洁,薛子超,李敬华,薛卫国 . 鼻腔鼻窦恶性肿瘤细胞周期的DNA分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 193 -195 .
[8] 陈文文 . 1例T/NK淋巴瘤17年演进[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 472 -472 .
[9] 赵鲁新,翟 洪,潘 洁 . 超声乳化吸除联合晶状体植入治疗急性闭角型青光眼伴白内障23例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 260 -262 .
[10] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .