Abstract：
BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leaks (SCSFL) occur in the absence of trauma, surgery, or underlying intracranial pathology. They represent a significant healthcare burden on patients with complications such as meningitis. We present our experience of SCSFL repair via the endonasal endoscopic approach.
METHODS: All patients who underwent CSF fistula repair at a tertiary UK hospital, between 1st January 2012 to 31st December 2019, were identified and had their case notes analyzed retrospectively.
RESULTS: There were 33 patients included consisting of 27 (81.8%) females, with age range from 31 to 81 years (mean 55.2). Mean body mass index (BMI) was 35.2 kg/m2 , with 32 (97.0%) patients overweight (BMI >25). All patients presented with intermittent watery rhinorrhoea and had a positive biochemical analysis. Computed tomography (CT) and/or magnetic resonance imaging (MRI) identified leak sites in 29 patients (87.9%). The most common intraoperative defect site was the cribriform plate (42.4%). A variety of closing techniques were used including onlay grafts (72.7%), tissue glue (87.9%), nasoseptal flaps (63.6%), mucosal free grafts (21.2%), fat grafts (21.2%), and additional support materials (87.9%). Nasal packing was used in all patients. The average length of stay was 1.6 days. Postoperative complications occurred in two patients (6.1%) (meningitis, epistaxis). Overall, there was a successful primary repair in 32 (97.0%) patients with most cases employing a multilayered reconstruction method (78.8%).
CONCLUSIONS: Our results demonstrate excellent success rates with the endoscopic endonasal approach to SCSFL. This adds to the literature by demonstrating a detailed analysis of the experience in SCSFL management in one of the largest UK centres.
METHODS: All patients who underwent CSF fistula repair at a tertiary UK hospital, between 1st January 2012 to 31st December 2019, were identified and had their case notes analyzed retrospectively.
RESULTS: There were 33 patients included consisting of 27 (81.8%) females, with age range from 31 to 81 years (mean 55.2). Mean body mass index (BMI) was 35.2 kg/m2 , with 32 (97.0%) patients overweight (BMI >25). All patients presented with intermittent watery rhinorrhoea and had a positive biochemical analysis. Computed tomography (CT) and/or magnetic resonance imaging (MRI) identified leak sites in 29 patients (87.9%). The most common intraoperative defect site was the cribriform plate (42.4%). A variety of closing techniques were used including onlay grafts (72.7%), tissue glue (87.9%), nasoseptal flaps (63.6%), mucosal free grafts (21.2%), fat grafts (21.2%), and additional support materials (87.9%). Nasal packing was used in all patients. The average length of stay was 1.6 days. Postoperative complications occurred in two patients (6.1%) (meningitis, epistaxis). Overall, there was a successful primary repair in 32 (97.0%) patients with most cases employing a multilayered reconstruction method (78.8%).
CONCLUSIONS: Our results demonstrate excellent success rates with the endoscopic endonasal approach to SCSFL. This adds to the literature by demonstrating a detailed analysis of the experience in SCSFL management in one of the largest UK centres.
摘要：
背景：自发性脑脊液（CSF）漏（SCSFL）发生在没有创伤的情况下，手术,或潜在的颅内病理。它们代表了患有诸如脑膜炎的并发症的患者的重大医疗负担。我们介绍了通过经鼻内镜方法进行SCSFL修复的经验。
方法：所有在英国三级医院接受CSF瘘修复的患者，在2012年1月1日至2019年12月31日期间进行了鉴定,并对其病例记录进行了回顾性分析.
结果：共纳入33例患者，其中27例（81.8%）女性，年龄范围从31到81岁（平均55.2）。平均体重指数(BMI)为35.2kg/m2,32例(97.0%)患者超重(BMI>25)。所有患者均出现间歇性水样鼻涕，生化分析呈阳性。计算机断层扫描（CT）和/或磁共振成像（MRI）确定了29例患者（87.9％）的渗漏部位。术中最常见的缺损部位是筛板(42.4%)。使用了多种闭合技术，包括内嵌移植物（72.7％），组织胶（87.9%），鼻中隔皮瓣(63.6%),无粘膜移植物（21.2%），脂肪移植物（21.2%），和额外的支持材料（87.9%）。所有患者均采用鼻腔填塞。平均逗留时间为1.6天。术后并发症发生在2例（6.1％）（脑膜炎，鼻出血）。总的来说,32例(97.0%)患者一期修复成功,大多数病例采用多层重建方法(78.8%).
结论：我们的研究结果表明，内镜经鼻入路治疗SCSFL的成功率很高。通过展示对英国最大的中心之一的SCSFL管理经验的详细分析，这增加了文献。
方法：所有在英国三级医院接受CSF瘘修复的患者，在2012年1月1日至2019年12月31日期间进行了鉴定,并对其病例记录进行了回顾性分析.
结果：共纳入33例患者，其中27例（81.8%）女性，年龄范围从31到81岁（平均55.2）。平均体重指数(BMI)为35.2kg/m2,32例(97.0%)患者超重(BMI>25)。所有患者均出现间歇性水样鼻涕，生化分析呈阳性。计算机断层扫描（CT）和/或磁共振成像（MRI）确定了29例患者（87.9％）的渗漏部位。术中最常见的缺损部位是筛板(42.4%)。使用了多种闭合技术，包括内嵌移植物（72.7％），组织胶（87.9%），鼻中隔皮瓣(63.6%),无粘膜移植物（21.2%），脂肪移植物（21.2%），和额外的支持材料（87.9%）。所有患者均采用鼻腔填塞。平均逗留时间为1.6天。术后并发症发生在2例（6.1％）（脑膜炎，鼻出血）。总的来说,32例(97.0%)患者一期修复成功,大多数病例采用多层重建方法(78.8%).
结论：我们的研究结果表明，内镜经鼻入路治疗SCSFL的成功率很高。通过展示对英国最大的中心之一的SCSFL管理经验的详细分析，这增加了文献。
