經腰椎蜘蛛膜下腔導管作連續性腦脊髓液引流治療功能性內視鏡鼻竇手術術後腦脊髓液鼻漏

Continuous Cerebrospinal Fluid Drainage Using a Lumbar Sybarachnoid Catheter for Cerebrospinal Fluid Rhinorrhea after Functional Endoscopic Sinus Surgery

麻醉醫師經常被會診放置腰椎蜘蛛膜下腔導管作腦脊髓液引流以幫助手術之進行或處理併發症。功能性內視鏡鼻竇手術在近十年來已廣泛用於治療慢性鼻竇炎，約可使百分之八十至九十一的病人病情緩解或治癒；但是仍有百分之八至十五點七的病人產生併發症，而腦脊隨液外滲是最為嚴重的併發症之一。我們提出一個經由腰椎蜘蛛膜下腔導管作連續性腦脊髓液引流治療成功的病例報告。七十一歲患有慢性鼻竇炎的男性病人在全身麻醉下接受功能性內視鏡鼻竇手術。在靜脈麻醉誘導及Sevoflurane的麻醉維持下，手術於九十分鐘後結束，並順利拔管。然手術後第二天移除加壓用鼻腔紗布之後，卻發現腦脊髓液鼻漏。術後第三天於病人腰椎蜘蛛膜下腔內置入一條十八號的導管作腦脊髓液引流，而腦脊髓液鼻漏的情形即獲得改善。分別在第一天引流出33毫升、第二天引流出64毫升、第三天引流出32毫升、第四天引流出50毫升、、第五天引流出65毫升。治療期間病人在第一天主訴頭暈，而不久即自行緩解；整個療程病人並沒有頸部僵硬、發燒、白血球增高等感染症狀。導管在五天後拔除，病人在手術後第八天順利出院。此一病例報告顯示，經腰椎蜘蛛膜下腔導管作連續性腦脊隨液引流之治療方式是處理功能性內視鏡鼻竇手術術後腦脊髓液鼻漏一可行且安全的方法。

Anesthesiologists are frequently consulted for performing lumbar cerebrospinal fluid (CSF) drainage to facilitate surgery or manage complications. Functional endoscopic sinus surgery (FESS) is a common treatment for chronic sinus diseases. Cerebrospinal fluid (CSF) leakage is a serious complication following FESS and is typically treated with an endonasal free or rotational mucoperichondrial flap. Continuous drainage of CSF with a lumbar subarachnoid catheter has been used in patients who have undergone neurosurgery but it is seldom used in the treatment of post-FESS CSF rhinorrhea. We present a 71-year-old male patient who suffered from CSF rhinorrhea after FESS, and was treated successfully with continuous lumbar CSF drainage. We are of the opinion that continuous CSF drainage with a lumbar subarachnoid catheter is an effective and safe modality of treatment for post-FESS CSF leakage.