| Background and Objective:Spontaneous cerebrospinal fluid rhinorrhea(SCFR)refers to cerebrospinal fluid rhinorrhea(CFR)that excludes trauma,tumor or any other iatrogenic causes.This disease is relatively rare.It’s clinical symptoms are atypical and easily be misdiagnosed,if not treated with standard treatment,it can cause recurrent meningitis;Meanwhile,For Conservative treatment often failes,surgical intervention is often required.Cerebrospinal fluid leakage repair was first reported by Dandy in 1926.Limited to the technical conditions at that time,Craniotomy repairs is the only option.It was criticized because of its excessive damage and high postoperative complications.Since 2000,A meta-study on neuroendoscopic repair of cerebrospinal fluid leakage was performed by Hassan M.It was pointed out that the success rate of the first endoscopic repair was about 90%;,the effective rate for patients with recurrent cerebrospinal fluid rhinorrhea is 52%.The overall effective rate of final neuroendoscopic repair was 97%.And the incidence of serious postoperative complications such as meningitis,subdural hematoma and intracranial abscess are all less than 1%.Endoscopic repair has gradually become the mainstream surgical method,and it has quickly replaced the traditional operation.However,whether Endoscopy has homogeneity in the repair of spontaneous cerebrospinal fluid rhinorrhea in different defect sites remains to be further explored.The purpose of this study is to evaluate the efficacy of neuroendoscopy in the treatment of patients with SCFR with different leakage sites,and to provide references for clinical diagnosis and treatment for such diseases.Methods:To retrospectively analyze the clinical data and out-of-hospital follow-up information of a total of 97 patients with SCFR,diagnosed and treated in The First Affiliated Hospital of Zhengzhou University from December 2015 to December 2019;and to statistically describe the characteristics and clinical symptoms of the affected population;To count the number of repairs and the most frequent locations of leaks,based on the location of the leak Classification;To analyze the specificity of different imaging diagnostic methods between HRCT and MRI;To compare the operation time and length of hospitalization for patients with different leak locations under endoscopy;To statistically compare the common postoperative complications;To contrast the one-time effective rate of endoscopic surgical repair at different follow-up time nodes.Results:1.Among the 97 patients,The numer of male patients were 24 and the sum of female patients were 73(male:female=24:73).There are more women patients(p=0.012).The average age of onset of women is 47.94±9.19 years,and the average age of onset of men is 44.68±13.31 years.The first symptom was sudden intermittent runny nose after catching a cold,43 cases(44.32%),54 cases(55.68%)had runny nose without obvious cause;23 cases(23.71%)had only headache symptoms,21 cases(21.64%)had only dizziness symptoms,8 cases(8.2%)had both headaches and dizziness symptoms 45 cases(46.45%)without obvious discomfort;54 cases(55.67%)were diagnosed as allergic rhinitis.Nineteen patients(19.60%)had intracranial infections before surgery,and most of them were within one month after the onset of rhinorrhea.2.According to the location of the leak during the operation,it is classified into frontal sinus group,ethmoid sinus group,sphenoid sinus group,ethmoid sinus group,and ethmoid apex group.The number of cases in each group is 9 cases(9.9%)and 10 cases respectively.(10.10%),16 cases(16.17%),35 cases(35.36%)and 27 cases(27.28%)3.HRCT has a difference in the detection rate of the five types of leaks,and the difference is statistically significant(χ2=11.445,P=0.02).It has the highest detection rate for the frontal and sphenoid sinus leaks.For the ethmoid sinus The detection rate of leaks is the lowest,with an overall detection rate of 30.9%;MRI has higher detection rates for different leaks,with an average effective rate of 93.8%,and there is no significant statistical difference,(χ2=2.395,P=0.664).4.The difference in the average age of onset of the five groups of patients was not statistically significant(F=0.959,P=0.43);there were significant differences in the average hospital stay of patients with different leakage sites(F=6.554,P=0.00);There are significant differences in the average operation time of patients in different groups(F=11.01,P＝0.00);and the average operation time and postoperative hospital stay of patients with the leakage in the frontal sinus are higher than those of other leakage groups There were no significant differences between the long,ethmoid ethmoid and ethmoid sinus groups.5.According to the results of regular follow-up,the success rate of one-off endoscopic repairs between 1 month,3 months,6 months and 12 months after surgery were 97.93%,95.87%,93.81%,and 91.75%,respectively.There were no obvious statistics difference were between above-mentioned groups(χ2=4.21,P=0.23).6.There were 5 cases(5.15%)of patients with leakage abscess formation after operation,5 cases(5.15%)with olfactory nerve injury after operation,3 cases(3.1%)with meningitis after operation,and abscess after frontal sinus leakage repair There is a statistically significant difference between the incidence of swelling and the incidence of abscesses around the leak after other parts of the repair,(χ2=51.55,P=0.00),the frontal sinus leak repair is more likely to form an abscess,which is in the forehead The incidence of sinus leakage was 56.0%.Conclusion:1.MRI is a simple and effective imaging method to locate the location of the SCFR leak.2.Repairing SCFR through neuroendoscopy can achieve an ideal repair success rate.3.The SCFR patients with a leak located in the frontal sinus require longer hospital-staying and operation time,and are prone to postoperative abscesses around the leak.Craniotomy should be used to cure the SCFR patients with frontal sinus leakage. |
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