The Characteristics And Treatment Of Empty Sella Combined Cerebrospinal Fluid Leakage Of Nasal

ObjectiveTo research and analysis the merger-specific clinical symptoms and pathogenesis of patients with empty sella combined cerebrospinal fluid leakage of nasal, explore the safe and effective surgical treatment for its high recurrence rate features to eliminate or alleviate the clinical symptoms and reducing the chance of relapses. Providing effective experiences and methods to prognosis earlier for such patients and prevention of recurrence.MethodsFrom October2006to November2011, There were8cases with empty sella merger cerebrospinal fluid leakage of nasal,7cases were accepted the repairing surgery of cerebrospinal fluid leakage in general anesthesia. Casel、3、5and7were accepted the repairing surgery of cerebrospinal fluid leakage used endoscope1time, the repair materials are autologous temporalis muscle and fascia; Case4、8were accepted the repairing surgery of cerebrospinal fluid leakage used endoscope2times, the repair materials are autologous temporalis muscle and fascia.Case6was accepted repairing surgery of cerebrospinal fluid leakage used endoscope merge craniotomy and ventricle celiac bypass, the repair material is acellular dermal matrix; case2recurrenced after repairing surgery of cerebrospinal fluid was recured after conservative treatment. Case1、2、4、5、6and8stayed in bed postoperative for three weeks and accepted lumbar drainaging for1week.Case7who refused lumbar drainaging was healed in reducing the intracranial pressure with mannitol and ambulatory conservative therapy.ResultsCase1with cerebral hemorrhage after cerebrospinal fluid rhinorrhea repair surgery was cured with craniotomy, followed for2years without recurrence. Case2who recurrenced2years later was recured after conservative treatment. Case3with cerebrospinal fluid rhinorrhea after transsphenoidal pituitary tumor resection three years ago was accepted cerebrospinal fluid rhinorrhea repair used endoscopic.Case4 recurrenced after surgery3years ago were accepted surgery again,followed one year without recurrence. Case5and7were accepted surgery,followed2years without recurrence.Case6who recurrence1year later was accepted repairing surgery of cerebrospinal fluid leakage used endoscope merge craniotomy and ventricle celiac bypass. Case8who recurrened5years later was accepted repairing surgery again.Conclusion1.The patient with empty sella combined cerebrospinal fluid leakage of nasal should be diagnosed with symptoms and conjunct with imaging studies, especially MRI.2.The patient with empty sella syndrome combined cerebrospinal fluid leakage of nasal was rare in clinical and the treatment of first choice was endoscopic sinus repair surgery, the sella augmentation surgery can be used to elevate the bottom of the sella. The surgery aim is to repair the leak port and try to eliminate the abnormal anatomy of the sella and relieve symptoms. in a It is in high success rate in endoscopic sinus surgery with few complications.3.Such patients can recur after surgical repair, the recurrence rate is up to50%. It can be a long time after surgery to recur about years or even for more than a decade. Most patients of recurrence were in primary benign high intracranial pressure.4.The patient in recurrence can accepted endoscopic cerebrospinal fluid leak repair surgery again, the patient with saddle septal defected can acceptable craniotomy saddle diaphragm repair. The patients in repeatedly recurrene can accepted the surgery of ventricle celiac bypass.5.These patients need long-term follow-up to prevent recurrence. The following indicators can be monitored include:headaches, fundus examination, the pituitary hormone inspection.