临床耳鼻咽喉头颈外科杂志2024,Vol.38Issue(7) :584-588.DOI:10.13201/j.issn.2096-7993.2024.07.005

自发性脑脊液耳漏的临床诊治分析

Clinical diagnosis and treatment analysis of spontaneous cerebrospinal fluid otorrhoea

张帆 张文静 轩晗 张紫玉 李素娟 孟娟 卢星 秦兆冰
临床耳鼻咽喉头颈外科杂志2024,Vol.38Issue(7) :584-588.DOI:10.13201/j.issn.2096-7993.2024.07.005

自发性脑脊液耳漏的临床诊治分析

Clinical diagnosis and treatment analysis of spontaneous cerebrospinal fluid otorrhoea

张帆 1张文静 1轩晗 1张紫玉 1李素娟 1孟娟 1卢星 1秦兆冰1
扫码查看

作者信息

  • 1. 郑州大学第一附属医院耳科(郑州,450052)
  • 折叠

摘要

目的:探讨自发性脑脊液耳漏的临床特点、影像学表现、手术方法及诊治经验.方法:回顾性分析2018年5月至2023年5月手术治疗的11例自发性脑脊液耳漏患者的临床资料,包括既往病史,影像学资料、漏口位置、手术修补方法、治疗效果及术后随访情况等.结果:11例手术患者,其中4例患者首诊为分泌性中耳炎,1例患者首诊为化脓性中耳炎,5例患者既往有脑膜炎病史或因脑膜炎为初次诊断而就诊;经耳道径路修补脑脊液漏2例,经乳突径路修补脑脊液漏9例;术中发现漏口位于镫骨底板4例,窦脑膜角1例,颅后窝合并颅中窝1例,颅中窝4例,内听道底及面神经管迷路段1例;10例患者1次修补成功,另1例患者术后出现颅内高压,最终行侧脑室腹腔分流术后症状解除.术后随访6个月~4年,无脑脊液耳漏及脑膜炎复发.结论:自发性脑脊液耳漏发病率低,临床症状不典型,延迟诊断或漏诊误诊率高;手术是目前治疗自发性脑脊液耳漏首选方法,通常可以取得满意的效果;诊疗过程中要警惕并重视颅内高压的存在,防止发生严重并发症及不可逆损伤.

Abstract

Objective:To investigate the clinical features,imaging findings,surgical methods,diagnostic and treatment experience of spontaneous cerebrospinal fluid otorrhoea.Methods:The clinical data of 11 patients with spontaneous cerebrospinal fluid otorrhoea treated surgically at our hospital from May 2018 to May 2023 were ret-rospectively analyzed.The medical data included medical history,imaging data,leak location,surgical repair method,treatment effect and postoperative follow-up.Results:Among the 11 surgical patients,4 patients were initially diagnosed with secretory otitis media,1 was initially diagnosed with purulent otitis media,and 5 patients had a history of meningitis or presented because meningitis as the initial diagnosis.There were 2 cases of cerebro-spinal fluid leakage repaired through the ear canal pathway and 9 cases of cerebrospinal fluid leakage repaired through the mastoid pathway.During the operation,leaks were located in the stapes floor plate in 4 cases,sinus meningeal angle in 1 case,posterior cranial fossa combined with middle cranial fossa in 1 case,middle cranial fossa in 4 cases,and labyrinthine segment of the internal auditory canal and facial nerve canal in 1 case.Ten patient was successfully repaired,and another patient developed intracranial hypertension after surgery,with symptoms allevi-ated by a lateral ventriculoperitoneal shunt.Postoperative follow-up ranged from 6 months to 4 years,and there was no CSF otorrhoea and meningitis recurrence.Conclusion:The incidence of spontaneous cerebrospinal fluid otorrhea is low,the clinical symptoms are atypical,and the rate of delayed diagnosis or missed diagnosis and mis-diagnosis is high.Surgery is currently the preferred treatment for spontaneous cerebrospinal fluid otorrhoea,and satisfactory results are usually achieved;During diagnosis and treatment,it is crucial to be vigilant for intracranial hypertension to prevent serious complications and irreversible damage.

关键词

脑脊液耳漏/自发性/颅内高压/脑膜炎

Key words

cerebrospinal fluid otorrhoea/spontaneity/intracranial hypertension/meningitis

引用本文复制引用

出版年

2024
临床耳鼻咽喉头颈外科杂志
华中科技大学同济医学院附属协和医院

临床耳鼻咽喉头颈外科杂志

CSTPCD北大核心
影响因子:0.831
ISSN:1001-1781
参考文献量5
段落导航相关论文