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Neurological Surgery No Shinkei Geka Volume 19, Issue 4 （April 1991）

Neurological Surgery 脳神経外科 19巻4号（1991年4月発行）

Japanese English

症例

外傷後10年目に発症した髄液鼻漏の1例 A Case of Traumatic Cerebrospinal Fluid Rhinorrhea Manifested Ten Years after Head Injury 宮崎芳彰 ¹ , 橋本卓雄 ¹ , 神吉利典 ² , 阿部聡 ³ , 中村紀夫 ³ Yoshiaki MIYAZAKI ¹ , Takuo HASHIMOTO ¹ , Toshinori KANKI ² , Satoshi ABE ³ , Norio NAKAMURA ³ ¹東京慈恵会医科大学第三病院脳神経外科 ²神奈川県立厚木病院脳神経外科 ³東京慈恵会医科大学脳神経外科 ¹Department of Neurosurgery, The Jikei University School of Medicine Daisan Hospital ²Department of Neurosurgery, Kanagawa Prefectural Atsugi Hospital ³Department of Neurosurgery, The Jikei University School of Medicine キーワード： Traumatic cerebrospinal fluid rhinorrhea , Cerebrospinal fluid rhinorrhea , Head injury , Skull fracture , Meningitis Keyword: Traumatic cerebrospinal fluid rhinorrhea , Cerebrospinal fluid rhinorrhea , Head injury , Skull fracture , Meningitis pp.375-378

発行日 1991年4月10日 Published Date 1991/4/10

DOI https://doi.org/10.11477/mf.1436900248

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Abstract 文献概要
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I．はじめに

　外傷に伴う髄液鼻漏は，頭部外傷の1-3％に合併^{11，15,19）}し，80-90％は，受傷後3ヵ月以内に発生^1,12,17）している．

　今回われわれは，受傷後10年目に髄膜炎で発症した外傷性髄液鼻漏の1例を経験したので，診断・治療について若干の文献的考察を加え報告する．

Abstract

In patients with head injury, the total incidence of CSF rhinorrhea was 1 - 3%, and in almost all cases, CSF rhinorrhea occurred within the first three months after injury. We report here a case of a 26 year-old male with CSF rhinorrhea manifested with meningitis who had once been admitted to hospital 10 years pre-viously with a head injury. He had a fracture which we thought had caused a CSF leakage in the left frontal skull base. After conservative treatment for a month we eventually undertook bifrontal craniotomy and repaired the cleft of the skull base with dura and fibrin.

In cases in which CSF rhinorrhea had occurred more than 10 years after head injury, including several re-ports in Japan, surgical treatment had always been re-quired. We think bifrontal craniotomy should be per-formed in such cases in which it is difficult to locate a cleft in the skull base before the operation. The field of view is wider during the intradural approach. To re-store an area with a lack of dura, highly anti-infectio-nary convexity dura is used a lot, and it is also thought that fibrin is effective in dural repair. The dural defi-cient areas take 3 to 4 months to repair perfectly, and postoperative observation of the patient's progress is required.