Clinical analysis of adult spontaneous cerebrospinal fluid rhinorrhea / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To discuss the clinical characteristics, diagnosis and treatment of adult spontaneous cerebrospinal fluid rhinorrhea (CSFR).@*METHODS@#A retrospective study was conducted on 18 patients of CSFR. Nasal secretion was collected for biochemical analysis. Imaging examination was done for identification of the bony defect in skull base.@*RESULTS@#In all cases, the glucose concentration of nasal secretion were more than 1.7 mmol/L, and the β-2 transferrin detected by immunoelectrophoresis technique were positive. Twelve cases were found to have bony defect in skull base. For the rest 6 cases without bony defect, MRI findings of 6 cases showed sinusoidal effusion with similar signals to cerebrospinal fluid, thus predicting the location of the leak. Conservative treatment was successful in one case, and the other 17 patients underwent endoscopic sinus surgery with computer assisted navigation system (CANS). The results of all cases underwent surgery were successful by one time. No recurrence occured during the follow-up time (11 to 24 months).@*CONCLUSIONS@#The incidence of adult CSFR is low, hence it is easily to be missed and misdiagnosed. The majority of CSFR patients are middle-aged and elderly obese women, often combined with hypertension, diabetes, moderate and severe osteoporosis due to no daily exercise habits. Correct medical history collection, reasonable preoperative examination and accurate preoperative localization of bony defect are essential for surgical repairment. CANS used during operation can enable surgeons to locate the site of leakage accurately and shorten the operation time.

Surgery of jugular foramen region tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the various surgical approaches in removing the jugular foramen region tumors in order to obtain the maximal functional preservation.</p><p><b>METHODS</b>Between March 1993 and May 2005, 32 patients with jugular foramen region tumors were operated. The mastoid and neck approach, the infratemporal fossa approach with and without rerouting the facial nerve, the combined transcochlear and infratemporal fossa approach were respectively used according to the tumor type, size, auditory, facial and lower cranial nerve functions. The cranial nerve monitoring was used and a postoperative CT or MRI scanning was taken in all cases.</p><p><b>RESULTS</b>In this series of 32 patients, 13 were paragangliomas, 10 schwannomas,2 meningiomas, 2 giant cell tumors, 1 chondrosarcoma, 1 mucochondrosarcoma, 1 adenoid cystic carcinoma, 1 rhabdomyosarcoma and 1 case cholesterol Granuloma. The follow-up period was 3-60 months. Total removals were achieved in 26 cases, near-total removal in 5 cases, and subtotal removal in one case. One patient died after surgery because of intracranial hemorrhage. Another patient died two year after operation because of recurrence. Postoperative cerebrospinal fluid leakage was occurred in 5 cases and meningitis in two cases. They were all treated conservatively. The facial function one week after operation was grade 1-2 in 13 cases, grade 3-4 in 12 cases and grade 5-6 in 7 cases. It changed into grade 1-2 in 23 cases, grade 3-4 in 7 cases and grade 5-6 in 2 cases. The postoperative hearing was improved in 4 cases, stable in 10 cases, deteriorated in 11 cases and totally lost in 7 cases. The lower cranial nerve function was normal in 9 cases, transient palsy in 11 cases, permanent paralysis with compensation in 10 cases and without compensation in 2 cases.</p><p><b>CONCLUSION</b>The jugular foramen region tumor could be removed with maximal function preservation by using various surgical approaches. The postoperative life quality was acceptable in most cases. Surgical techniques and postoperative complications management were fundamental in achieving a good result.</p>