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.

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