摘要
目的 探讨成人自发性脑脊液耳漏(spontaneous cerebral spinal fluid otorrhea,SCSFO)的临床特点及治疗.方法 回顾性分析2015年6月至2022年6月河北医科大学第二医院耳鼻咽喉头颈外科收治的4例成人SCSFO患者的临床病例资料.4例患者术前均曾被误诊为分泌性中耳炎;病例1和病例3漏口位置在乳突盖,病例4漏口位置在鼓室盖,3例均采用经乳突入路的手术方式;病例2漏口位置在鼓室盖,采用乳突切除+腹部脂肪填塞耳道封闭术.结果 3例患者经手术治疗取得满意效果,病例4术后仍有耳漏,行保守治疗后耳漏消失,所有病例随访6月～7年6月,平均随访时间4年3月,均未复发.结论 成人SCSFO临床罕见,易被误诊为分泌性中耳炎,颞骨高分辨率CT(high resolution CT,HRCT)和核磁共振(magnetic resonance imaging,MRI)对于诊断和漏口部位的判断及手术方式的选择具有重要价值和意义.
Abstract
Objective To report clinical features and treatment of adult spontaneous cerebrospinal fluid otorrhea.Methods Clinical data of 4 patients suffering from spontaneous cerebrospinal fluid otorrhea surgically treated in our de-partment between June 2015 and June 2022 were retrospectively analyzed.All 4 cases were misdiagnosed as secretory otitis media.Defects were located to the tegmen mastoideum in cases 1 and 3,and to the tegmen tympani in cases 4,all surgically repaired through the transmastoid approach.Defect was located in the tegmen tympani in case 2 with brain tis-sue prolapsed to the tympanum,partly wrapping the ossicles and repaired by mastoidectomy plus adipose tissue pack-ing.Results Satisfactory results were achieved after primary repair in cases 1 and 3.Otorrhea initially persisted after pri-mary repair in case 4 but resolved with conservative treatments.No recurrence occurred during followed ups(6 months to 7 years and 6 months,average=4 years and 3 months).Conclusion Pre-operative temporal bone HRCT and MRI scans for diagnosis are important to ensure accurate location of leakage site and appropriate surgical planning.
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