두개저 외과수술에서 뇌척수액 비루의 치료

Abstract

Objective : In various skull base approaches, the risk of cerebrospinal fluid (CSF) leakage exists and the leakage may lead to a life-threatening condition such as meningoencephalitis. The incidence of its occurrence varies in previous literatures and the management dealing the leakage was not established. In this study, we reviewed our experiences dealing CSF leakage after a skull base surgery and suggest a guideline of managing CSF leakage. Patients and Methods : From 2001 to 2007, 273 patients who underwent skull base surgery for managing tumor were reviewed retrospectively. The charts were analyzed for the date of surgery, age and sex of the patient, the presence or absence of CSF leak, and when present, its managements. Results : Among the 273 patients, six patients had CSF leakage after surgery. The incidence of CSF leakage in this series was 2.19%. The risk of CSF leakage was highest in the retrosigmoid and combined approaches (3.03%). Two of these patients with CSF leakage developed bacterial meningitis, and these two patients with meningitis were treated with intravenous antibiotics. Among the six patients, the CSF leakage had improved without a direct surgical repair of dural defect in four patients; the others underwent a surgical repair. Conclusions : Our results indicate that postoperative CSF leakage can be managed activity restriction, and lumbar-subarachnoid drainage, but in case of refractory leakage, wound revision and surgical dural defect repair enables the patients to reduce hospital days and further complications.