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林口長庚醫院 陳安婕 指導 : 張伯宏 / 黃啟哲 / 李達人 醫師

鼻內視鏡修補蝶竇外側隱窩之腦脊髓液漏 Management of Cerebrospinal Fluid Leakage in Sphenoid Lateral Recess and a Postoperative Complication. 林口長庚醫院 陳安婕 指導 : 張伯宏 / 黃啟哲 / 李達人 醫師. 30% people in Taiwan have allergy. Spontaneous CSF leak ?. But persistent ipsilateral clear rhinorrhea without reason.

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林口長庚醫院 陳安婕 指導 : 張伯宏 / 黃啟哲 / 李達人 醫師

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  1. 鼻內視鏡修補蝶竇外側隱窩之腦脊髓液漏Management of Cerebrospinal Fluid Leakage in Sphenoid Lateral Recess and a Postoperative Complication 林口長庚醫院陳安婕 指導: 張伯宏/黃啟哲/李達人醫師

  2. 30% people in Taiwan have allergy Spontaneous CSF leak ? But persistent ipsilateral clear rhinorrhea without reason

  3. Case presentation

  4. 49-year-old female • BMI 31.5 (77.6kg/1.57m) • Occupation: house wife • Past history • Mild hypertension, under medication control • Denied trauma history and operation history • Chief complaint • Right intermittent clear rhinorrhea for 8+ months, protracted clear rhinorrhea for 2 months • Sometimes choking due to copious postnasal drip • Frontal headache, No nasal obstruction • Refractory to oral medication

  5. Laboratory data

  6. Image MRI CT

  7. Ordinary sphenoid sinus Corridor to get into lateral recess

  8. Treatment plan

  9. Lesion during surgery and postoperatively During surgery 1/2 year after surgery Nasoseptal flap

  10. Cause of Spontaneous CSF Leakage Intracranial hypertension Trauma Congenital Surgery Tumor

  11. A rare complication: acute hydrocephalus after repair • Another case of sphenoid lateral recess CSF leak repair • Progressive drowsiness developed less than 10 hours postoperatively (after removing lumbar drain) • CT: obstructive hydrocephalus with enlargement of lateral ventricles • Emergent external ventricular drain with subsequent V-P shunt Otolaryngol Head Neck Surg. 2008 Oct;139(4):602-3

  12. Intervention for elevated ICP after repair • A systemic review • Total 679 patients • ICP intervention: Acetazolamide or CSF shunt system • Conclusion: Intervention was associated with improved successful rate Laryngoscope. 2017 Sep;127(9):2011-2016

  13. Conclusion

  14. CSF leak may happen spontaneously • Obesity, sleep apnea and female are risk factors of spontaneous CSF leakage • Transpterygoid approach is an minimal invasive and effective method to repair CSF leak in sphenoid lateral recess • Postoperative monitoring of ICP is necessary and important

  15. Thank you for attention !!

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