在过去的几年中,自发性脑脊液(CSF)漏/鼻漏与特发性颅内高压(IIH)之间的关联已得到越来越多的认识。然而,关于评估的意见分歧很大,调查,自发性脑脊液鼻漏患者的管理仍然存在。
来自欧洲的专家组成了一个共识小组,亚洲,澳大利亚,南美和北美。在文献综述和与小组成员的公开讨论之后,产生了一组61个陈述。在2019年9月的Santo-Rhino会议上,通过3轮问卷和一次共识小组会议,采用改进的Delphi方法细化专家意见。
关于自发性CSF泄漏和IIH的50份声明(占总数的82%)达成共识。在50份声明中的38份中,中位应答为7(强烈同意),在其余12份陈述中,中位应答为6(同意).由于未达成共识,因此排除了11项声明,并在SantoRhino会议期间增加了一项新声明。最终陈述参考患者病史和临床检查(“病史应包括头痛的存在,耳鸣和视觉缺陷“),调查(薄层计算机断层扫描和CISS/FLAIR序列在磁共振成像中的作用),管理原则(观察等待或减少ICP的措施是补充的,但不能替代手术闭合),外科技术,术中,术后早期和长期管理。
我们提出了关于诊断的50个共识声明,调查,根据现有证据和专家意见,自发性脑脊液鼻漏的处理。尽管绝不是全面和最终的,我们相信它们可以为临床实践的标准化做出贡献。早期诊断,及时手术闭合缺损,综合多学科方法对潜在并存的特发性颅内高压进行评估和治疗对于成功管理自发性脑脊液鼻漏至关重要。降低相关发病率并防止复发。
The association between spontaneous cerebrospinal fluid (CSF) leak/rhinorrhea and idiopathic intracranial hypertension (
IIH) has been increasingly recognized over the last years. However, considerable variability of opinion regarding the assessment, investigations, and management of patients with spontaneous CSF rhinorrhea remains.
A
consensus group was formed from experts from Europe, Asia, Australia, South and North America. Following literature review and open discussions with members of the panel, a set of 61 statements was produced. A modified Delphi method was used to refine expert opinion with 3 rounds of questionnaires and a
consensus group meeting in Santo-Rhino meeting in September 2019.
Fifty statements (82% of total) on spontaneous CSF leak and
IIH reached
consensus. In 38 of 50 statements, the median response was 7 (strongly agree) and in the 12 remaining statements the median response was 6 (agree). Eleven statements were excluded because they did not reach
consensus and one new statement was added during SantoRhino meeting. The final statements refer to patient history and clinical examination (\"History taking should include presence of headache, tinnitus and visual defects\"), investigations (role of Thin Slice Computed Tomography and CISS/FLAIR sequences in Magnetic Resonance Imaging), principles of management (watchful waiting or measures to reduce ICP are supplementary but cannot subsitute surgical closure), surgical technique, intraoperative, early postoperative and long term management.
We present fifty consensus statements on the diagnosis, investigation, and management of spontaneous CSF rhinorrhea based on the currently available evidence and expert opinion. Although by no means comprehensive and final, we believe they can contribute to the standardization of clinical practice. Early diagnosis, prompt surgical closure of the defect, assesment for and treatment of potentially co-existing idiopathic intracranial hypertension in a comprehensive multidisciplinary approach are essential in order to successfully manage spontaneous CSF rhinorrhea, reduce associated morbidity and prevent recurrence.