不同类型脑脊液鼻漏的治疗策略

Treatment strategies for different types of cerebrospinal fluid rhinorrhea

摘要:

目的 通过总结不同类型脑脊液鼻漏的临床特征与治疗方案，探讨游离中鼻甲黏膜瓣在脑脊液鼻漏修补中的应用价值。方法 回顾性分析2021年9月—2025年1月于南华大学衡阳医学院附属长沙中心医院耳鼻咽喉头颈外科收治的66例脑脊液鼻漏患者的临床资料。患者病因主要包括自发性、外伤性、医源性及肿瘤源性4类，针对性采取不同的手术治疗方式，术后定期随访，对手术效果及并发症进行评估。结果 最常见的颅底缺损部位为筛板（18例，27.3%）、筛顶（14例，21.2%）及蝶窦外侧隐窝（12例，18.2%）。自发性脑脊液鼻漏患者的体质指数（BMI）、甘油三酯、女性比例、高血压比例均高于非自发性脑脊液鼻漏患者(P＜0.05)。51例手术患者根据漏口部位及大小，采取不同的颅底修复技术，均重建成功，术后随访≥6个月，无复发，其中31例患者（60.8%）采用游离中鼻甲黏膜瓣进行修补。结论 临床治疗脑脊液鼻漏需结合漏口部位特征与患者个体差异制订方案。采用游离中鼻甲黏膜瓣联合自体筋膜的内镜下修补术，是治疗脑脊液鼻漏的一种安全、有效的术式，弥补了传统术式材料选择局限和创伤较大的不足。通过规范诊疗流程可最大化发挥该术式的微创优势，为脑脊液鼻漏的精准修补提供新的治疗方法。

Abstract:

Objective To explore the application value of the free middle turbinate mucosal flap in cerebrospinal fluid rhinorrhea (CSFR) repair, this retrospective study summarizes the clinical characteristics and treatment regimens of different types of CSFR. Methods A retrospective analysis was performed on the clinical data of 66 CSFR patients admitted to the Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, from September 2021 to January 2025. The etiologies of the patients mainly included four categories: spontaneous, traumatic, iatrogenic, and tumor-induced. Different treatment methods were adopted, and regular postoperative follow-up was conducted to evaluate the surgical efficacy and complications. Results The most common sites of skull base defects were the cribriform plate (18 cases, 27.3%), the ethmoid roof (14 cases, 21.2%), and the lateral recess of the sphenoid sinus (12 cases, 18.2%). Patients with spontaneous cerebrospinal fluid rhinorrhea had significantly higher BMI, triglyceride levels, female proportion, and hypertension prevalence compared with those with non-spontaneous cerebrospinal fluid rhinorrhea (P＜0.05). Based on the location and size of the fistula, a total of 51 patients underwent individualized skull base reconstruction techniques.All 51 surgical patients achieved successful reconstruction. Postoperative follow-up for ≥6 months showed no recurrence. Among these patients, 31 cases (60.8%) underwent repair using the free middle turbinate mucosal flap. Conclusions The treatment of clinical CSFR should be formulated, which was based on the characteristics of the fistula locations and the patient individual differences. The endoscopic repair with free middle turbinate mucosal flap combined with autologous fascia is a safe and effective surgical method for the treatment of CSFR.This approach overcomes the deficiencies of traditional surgical procedures such as limited material selection and great trauma. It is suggested that the minimally invasive value of this surgical method should be maximized through standardized diagnosis and treatment processes.This precise surgical repair approach for CSFR offers a novel therapeutic option.