Cerebrospinal fluid rhinorrhea
Introduction
Introduction to cerebrospinal fluid rhinorrhea Cerebrospinal fluid rhinorrhea (CFR) is cerebrospinal fluid (CSF) that flows out through the skull base (pre-cranial, middle or posterior fossa) or other parts of the bone defect, rupture, through the nasal cavity, and finally out of the body. Mainly manifested as nasal intermittent or continuous flow of clear, watery liquid, early mixed with blood, the liquid can be light red. Cerebrospinal fluid rhinorrhea has a variety of classification methods, based on anatomy, etiology, intracranial pressure. Because etiology affects the treatment and prognosis of cerebrospinal fluid rhinorrhea, it is clinically most valuable according to the cause classification. According to the cause of cerebrospinal fluid rhinorrhea, it is divided into traumatic and non-invasive, and the latter is divided into spontaneous, neoplastic and congenital. Cerebrospinal fluid rhinorrhea caused by clinical trauma is the most common. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: low intracranial pressure syndrome
Cause
Cerebrospinal fluid rhinorrhea
Causes
The causes of cerebrospinal fluid rhinorrhea can be divided into traumatic and non-traumatic, of which trauma can be divided into traumatic and iatrogenic; non-traumatic can be divided into spontaneous, neoplastic and congenital.
Pathophysiology
The skull base has bone defects or rupture due to various reasons, accompanied by tearing of the dura mater or long-term compression and rupture. The cerebrospinal fluid flows from the intracranial cavity through the skull base bone defect to the nasal cavity or sinus.
Prevention
Cerebrospinal fluid rhinorrhea prevention
Cerebrospinal fluid rhinorrhea is a common complication of neurosurgery. Through the implementation of a series of measures, this article avoids the increase of intracranial pressure and promotes the early healing of the leak. Cerebrospinal fluid rhinorrhea is generally secondary to skull base and frontal bone fractures, and post-cranial tumor surgery is a common complication of neurosurgery, which can cause intracranial infection and endanger the life of patients. Therefore, active prevention, early detection, and early treatment are important in promoting the healing of leakage and preventing retrograde infection.
Complication
Cerebrospinal fluid rhinorrhea complications Complications, low intracranial pressure syndrome
Cerebrospinal fluid rhinorrhea complications may include intracranial infection and low intracranial pressure.
Symptom
Cerebrospinal fluid rhinorrhea symptoms common symptoms nasal discharge
Mainly manifested as nasal intermittent or continuous flow of clear, watery liquid, early mixed with blood, the liquid can be light red. More common on one side. In the case of a low-head force, compression of the jugular vein, etc., there is a tendency to increase the flow rate, suggesting that the cerebrospinal fluid rhinorrhea may be. Traumatic cerebrospinal fluid rhinorrhea can also have bloody fluid flowing out of the nostrils at the same time. The center of the trace is red and the periphery is clear, or the colorless liquid flowing out of the nostrils does not appear sick after drying. The cerebrospinal fluid rhinorrhea should be thought of. It occurs more often after injury, and late-onset can occur in days, weeks, or even years.
Examine
Examination of cerebrospinal fluid rhinorrhea
Auxiliary inspection
Nasal endoscopy
Can be used routinely, positioning leaks accurately. When the cerebrospinal fluid continues to flow out, the endoscope may directly find the part of the cerebrospinal fluid rhinorrhea. When the cerebrospinal fluid leaks less or intermittently flows out, intrathecal fluorescein may be used together to find the leak. During the examination, the intracranial pressure of the bilateral internal jugular vein was increased, which was beneficial to the observation of the leak.
Glucose oxidase assay
This technique is a traditional diagnostic method. Because tears and nasal mucus are sugary, the sugar is not reliable and can be quantitatively tested. The concentration of glucose in the nasal leakage is measured and compared with the concentration of glucose in the serum. If the ratio is 0.50 to 0.67, the leakage is likely to be cerebrospinal fluid under other factors that may cause changes in the concentration of glucose in the cerebrospinal fluid and serum. If the glucose concentration in the leakage liquid is greater than 1.7mmol, the diagnosis can be confirmed.
-2-2 transferrin assay
This technique is very effective in the diagnosis of cerebrospinal fluid rhinorrhea. Since -2 transferrin is only present in the cerebrospinal fluid and the inner ear lymph, it is not detectable in the blood, nasal and external auditory canal secretions. 0.2 mL of the specimen was taken and detected by immunofixation electrophoresis, and its sensitivity and specificity were high.
--2 tracer protein detection
In recent years, it has been found that the -2 tracer protein is only present in the cerebrospinal fluid and the outer ear lymph, and its sensitivity and specificity are higher.
CT and CT cerebral angiography
High-resolution CT, the layer thickness can be as thin as 1 mm, and the detection rate of small lesions is significantly improved. Three-dimensional CT imaging technology to reconstruct the skull base, more intuitive display of fractures, to identify the leak site. CT cerebral cisography has a high specificity and can directly display the shape, size, location and number of leaks in cerebrospinal fluid rhinorrhea. However, it is not possible to fully understand the leak condition, and the bone structure is unclear. Combined with CT, it is more perfect.
Intrathecal and local fluorescein method
Intrathecal injection of fluorescein combined with endoscopy is a common method for intraoperative cerebrospinal fluid leakage, which is helpful for the diagnosis of cases with less leakage or intermittent cerebrospinal fluid rhinorrhea. The intraoperative visual field exposure is larger and the diagnosis is accurate, but the exposure to the skull base defect is small, and the precise positioning of the leak is limited. Local intranasal fluorescein method can be used for preoperative diagnosis, intraoperative localization and postoperative recurrence. It is non-invasive, simple and safe, and has high sensitivity.
MRI and MRI water imaging
The most easily leaking position of the cerebrospinal fluid, that is, the prone position, the T1-weighted T2-weighted image of the axial, sagittal or coronal position and the fast spin echo T2 weighted image of fat suppression can be used to determine the cause and leakage. Part. MRI water imaging technology, which is widely used, locates leaks accurately.
Diagnosis
Diagnosis and diagnosis of cerebrospinal fluid rhinorrhea
The diagnosis of cerebrospinal fluid rhinorrhea mainly depends on symptoms, signs and auxiliary examinations. Symptoms: One or both sides of the nostrils continue to flow intermittently or intermittently. The symptoms are aggravated when tilting to one side, bowing or pressing the jugular vein; or leaking less, but the pillow is wet in the morning. There are also only repeated intracranial bacterial infections, and the rhinorrhea is not obvious. The general incidence is more than traumatic brain injury, after surgery, a small number of patients have only had a history of mild head injury or nasal leakage after sneezing.
Differential diagnosis
Allergic rhinitis
Symptoms of watery sputum may appear in the onset of allergic rhinitis and should be differentiated from this disease. However, allergic rhinitis is accompanied by continuous sneezing, nasal itching, nasal congestion, and has a clear allergen. Biochemical examination of secretions can be identified.
Submucosal cyst of the sinus
Submucosal cysts of the sinus are most common in the maxillary sinus. When the cyst is ruptured, yellow liquid can flow out. One side should be identified. Feasible imaging and biochemical tests.
