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目的探讨经鼻内镜下翼突径路处理蝶窦外侧隐窝脑膜脑膨出的手术方式及其相关问题。方法总结2001-2006年住院诊断为蝶窦外侧隐窝脑膜脑膨出并脑脊液鼻漏9例患者,男6例,女3例;年龄27～56岁。其中2例患者有前期经鼻内镜手术修补史。术前 CT 扫描和磁共振脑池造影检查定位诊断脑脊液鼻漏和脑膜脑膨出。在全身麻醉下行经鼻内镜下翼突径路切除蝶窦外侧隐窝脑膜脑膨出并修补颅底手术。结果 9例患者均一次手术修补成功。1例术后并发颅内高压和脑积水,2例术后合并患侧面部、硬腭和上唇麻木,1例干眼。术后6个月症状逐渐缓解。随访6～58个月,平均25.6个月,无复发。结论蝶窦外侧隐窝脑膜脑膨出伴脑脊液鼻漏采用鼻内镜下经翼突进入蝶窦外侧隐窝术式,为一微创技术和简便手术径路。
Objective To investigate the operative methods and related problems of meningeal encephalocele in the lateral sphenoid sinus treated by aponeurotomy via nasal endoscopic approach. Methods From 2001 to 2006, 9 cases of male patients with sphenoid bulge and cerebrospinal fluid rhinorrhea were diagnosed as inpatients, 6 males and 3 females, aged from 27 to 56 years. Two of the patients had a history of nasal endoscopic surgery. Preoperative CT scan and magnetic resonance cholangiography were used to diagnose cerebrospinal fluid rhinorrhea and meningoencephalocele. Under general anesthesia under nasal endoscopic papillary excision of the sphenoid sinus lateral meninges encephalocele and repair skull base surgery. Results All the 9 patients were successfully surgically repaired. One case was complicated by intracranial hypertension and hydrocephalus. Two cases had numbness on the lateral face, hard palate and upper lip after operation, and one case had dry eye. 6 months after the symptoms gradually eased. All cases were followed up for 6 to 58 months with an average of 25.6 months without recurrence. Conclusions The lateral sphenoid sinomenurasion associated with cerebrospinal fluid rhinorrhea in the lateral crypt of the sphenoid sinus is a minimally invasive technique and a simple surgical approach via endoprosthesis into the lateral sphenoid sinus crypt.