術後に生じた鼻性髄液漏の耳鼻科的アプローチ

Transnasal Approach for Persistent Postoperative CSF Leaks

　緒言

　脳外科的あるいは耳鼻科的な手術後に起こる髄液漏は，ときに部位診断に手間取ったり，ひとたび髄液漏を生じるとしばしば難治性となり，治療に難渋することがある。

　今回われわれは，脳外科での海綿静脈洞動脈瘤，脳下垂体腫瘍の術後，および耳鼻科での副鼻腔炎手術の術後に生じた鼻性髄液漏に遭遇し，耳鼻科的アプローチにより治療を試みた。これらの症例を報告するとともに若干の考察を加えた。

The advent of functional transnasal sinus sur-gery has brought opportunities in repair of difficult cerebrospinal fluid (CSF) leaks of the paranasal sinuses. Three patients in our clinic received repair of cerebrospinal fluid leaks with the use of fibrin sealant. The cases included carotid artery aneurysm, pituitary adenoma, and chronic sinu-sitis. Each case suffered from CSF leak postope-ratively.

Surgical techniques in transnasal approach in repair of sphenoid and ethomoid cerebrospinal fluid fistulas was reported, and etiology, diagnosis, and treatment of cerebrospinal fluid rhinorrhea were discussed.