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目的探讨脑脊液鼻漏的病理机制、定位诊断及治疗方法。方法总结分析21例外伤性迁延性脑脊液鼻漏的术前CT、CT脑池造影(CTC),与术中所见相比较,评估其诊断价值,从而术前准确定位漏口。结果术中见17例患者神经组织疝入鼻安,16例CT扫描显示骨缺损,所有病例CTC所显示漏口与术中所见完全一致。所有病例术后无复发,无手术并发症。结论神经组织经颅底缺损疝入鼻窦为外伤后脑脊液鼻漏不能自愈的重要病理机制,南于神经组织的疝入,导致黏膜、硬膜、蛛网膜难以修复。CTC可准确确定瘘口部位,4周内不能自愈的脑脊液鼻漏应积极早期手术治疗。
Objective To investigate the pathological mechanism of cerebrospinal fluid rhinorrhea, diagnosis and treatment methods. Methods Totally 21 cases of traumatic persistent cerebrospinal fluid rhinorrhea were analyzed by CT and CT. The diagnostic value of CT and CT was compared with that of intraoperative findings, and the leakage was accurately located before operation. Results In the operation, 17 cases were found to have nasal inguinal nerves and 16 cases of CT scans showed bone defects. All the cases of CTC showed the exact coincidence with the intraoperative findings. No recurrence of all cases, no surgical complications. Conclusions The herniation of the sinonasal tissue through the skull base defect of the nervous tissue is an important pathological mechanism of the cerebrospinal fluid rhinorrhea that can not be self-healing after the traumatic injury. The hernia infiltration into the nerve tissue in the south leads to difficulty in repairing mucosa, dura mater and arachnoid. CTC can accurately determine the fistula site, within 4 weeks of cerebrospinal fluid rhinorrhea should be self-healing positive early surgical treatment.