颅脑外伤后顽固性脑脊液耳漏的手术策略和技巧研究

doi:10.6040/j.issn.1673-3770.0.2015.272

Abstract

Abstract: Objective To explore the surgical strategies and techniques in the management of refractory cerebrospinal fluid (CSF) otorrhea. Methods Combined subtemporal trasnscranial and transmastoid approach was performed to repair the middle cranial fossa defects in 11 patients with posttraumatic CSF otorrhea. Results (1) Mastoid probe was not required in 5 cases. Due to comminuted fractures of mastoid process, 2 cases needed titanium plate fixation before the bone flaps were removed. In the other 4 cases with serious mastoid fracture, the pieces were collected and refilled back to the defect, and fixed together with longissimus by biological glue. (2) The brain tissues herniation and/or exposed mastoid mucosa via large skull base defects were observed intraoperatively in 6 cases. (3) The ossicular chain was intact in 3 cases, disappeared in 2 cases, and not inspected in 4 cases; the otosteon (malleus) was missed in 2 cases. No recurrence was recorded during the follow-up of 2-11 years. Conclusion (1) A combined supra-infratentorial approach, with an incision incorporating both the middle skull base and mastoid process, is advisable for the management of CSF otorrhea with complex fractures, especially with unstable fractures involving the mastoid process. (2) Postoperative rhinorrhea could be prevented by tamponade of tympanic cavity, especially, the eustachian tube, in addition to obliteration of the external auditory canal during surgical repair of CSF leaks in patients with complex fractures and hearing loss. (3) Inadvertent injury to petrous segment of the internal carotid artery should be avoided during surgical manipulations near tympanic cavity and eustachian tube.

Key words: Craniocerebral trauma, Surgical strategies, Cerebrospinal fluid otorrhea, Reconstruction of skull base

CLC Number:

R651

ZHANG Bin, LI Feng, ZHANG Liangwen, YANG Yang, ZHU Shugan. Surgical strategies and techniques in the management of refractory cerebrospinal fluid otorrhea[J].JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(6): 17-21.

References

[1] Kamochi H, Kusaka G, Ishikawa M, et al. Late onset cerebrospinal fluid leakage associated with past head injury [J]. Neurol Med Chir (Tokyo), 2013, 53(4):217-220.
[2] 王其友, 蓝信堂. 中耳炎并脑脊液耳漏[J]. 耳鼻喉学报, 1996, 10(2):107-108. WANG Qiyou, LAN Xintang. Otitis media with cerebrospinal otorrhea [J]. J Otolaryngol, 1996, 10(2):107-108.
[3] Brown N E, Grundfast K M, Jabre A, et al. Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea[J]. Laryngoscope, 2004, 114(5):800-805.
[4] Gacek R R, Gacek M R, Tart R. Adult spontaneous cerebrospinal fluid otorrhea:diagnosis and management [J]. Am J Otol, 1999, 20(6):770-776.
[5] Glasscock M E, Dickins J R E, Jackson C G, et al. Surgical management of brain tissue herniation into the middle ear and mastoid [J]. Laryngoscope, 1979, 89(11):1743-1754.
[6] Pelosi S, Bederson J B, Smouha E E. Cerebrospinal fluid leaks of temporal bone origin:selection of surgical approach [J]. J Clin Skull Base, 2010, 20(4):253-259.
[7] Wilson J T, Leivy S W, Sofferman R A, et al. Mondini dysplasia: spontaneous cerebrospinal fluid otorrhea [J]. Pedia Neurosurg, 1990, 16(4-5):260-264.
[8] Kim L, Wisely C E, Dodson E E. Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks:hearing improvement and success of repair [J]. Otolaryngol Head Neck Surg, 2014, 150(3):472-478.
[9] Agrawal A, Baisakhiya N, Deshmukh P T. Combined middle cranial fossa and trans-mastoid approach for the management of post-mastoidectomy CSF otorrhoea[J]. Indian J Otolaryngol Head Neck Surg, 2011, 63(Suppl 1):142-146.
[10] Rhoton A L Jr. The temporal bone and transtemporal approaches [J]. Neurosurgery, 2000, 47(3):S211-265.
[11] Tummala R P, Coscarella E, Morcos J J. Transpetrosal approaches to the posterior fossa[J]. Neurosurg Focus, 2005, 19(2):E6.
[12] 吴大海, 秦洁, 郭晓虹, 等. 鼻内镜下脑脊液鼻漏修补术前漏口定位方法[J]. 山东大学耳鼻喉眼学报, 2013, 27(5):37-40. WU Dahai, QIN Jie, GUO Xiaohong, et al. Ventage location in cerebrospinal fluid rhinorrhea under endoscopy in 16 cases[J]. J Otolaryngol Ophthal Shandong Univ, 2013, 27(5):37-40.
[13] Friedman J A, Ebersold M J, Quast L M. Post-traumatic cerebrospinal fluid leakage[J]. World J Surg, 2001, 25(8):1062-1066.
[14] Brodie H A, Thompson T C. Management of complications from 820 temporal bone fractures[J]. Am J Otol, 1997, 18(2):188-197.
[15] 宋西成,张庆泉,张华,等.影像导航系统在耳鼻咽喉颅底外科的应用[J].山东大学耳鼻喉眼学报, 2005, 19(5):291-293. SONG Xicheng, ZHANG Qinqquan, ZHANG Hua, et al. Application of image guidance system in otorhinolaryngology and skull base surgery[J]. J Otolaryngol Ophthal Shandong Univ, 2005, 19(5):291-293.
[16] 满都乐歌齐, 朱树干, 杨扬,等. 数字化颅底外科的解剖及影像学研究[J]. 山东大学耳鼻喉眼学报, 2013, 27(2):60-63. Mandulegeqi, ZHU Shugan, YANG Yang, et al. Digitalized skullbase surgery: an anatomical and medical imageology study[J]. J Otolaryngol Ophthal Shandong Univ, 2013, 27(2):60-63.

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