The majority of acute cerebrospinal fluid nasal or ear leaks caused by skull base fractures can be cured by non-surgical treatment, and only a small number of people who persist for more than 3 to 4 weeks are considered for surgical treatment. The treatment principles are as follows: a. Non-surgical treatment: Generally, the head is placed in a 30° high position, lying on the affected side so that the brain tissue sinks at the leaky hole to facilitate the adhesion and healing, at the same time, the nasal cavity or ear canal should be cleaned to avoid blowing the nose and coughing and holding the breath, keeping the bowels open, limiting the amount of fluid intake, and appropriately applying drugs that reduce cerebrospinal fluid secretion, such as acetazolamide, mannitol, and diuretic dehydration.
Mannitol diuretic dehydration. If necessary, lumbar puncture can also be performed to reduce or stop the leakage, about 85% of patients with cerebrospinal fluid nasal leakage and ear leakage can be healed after 1-2 weeks of palliative care. Surgical treatment: Cerebrospinal fluid leak repair is required only if the leak does not heal over time or if it recurs several times after self-healing. The method is: 1, cerebrospinal fluid nasal leak repair: before the operation must be carefully done to locate the leak hole, determine the location of the leak, the affected side or bilateral frontal bone flap craniotomy, the first should be through the epidural exploration, according to the site determined before the operation, the dura from the frontal sinus posterior wall orbital parietal crest or sieve plate area carefully separated, where the leak hole is often visible in the dura thickening and into the fracture suture, should be separated as close as possible to the skull, do not make The soft tissue of the skull at the fracture hole is electrocauterized and pushed into the bone suture, or into the sinus cavity if it is the sinus wall, then the skull fracture is closed with bone wax or medical gel, and then the fracture hole in the dura is closely sutured or repaired. Usually, temporalis fascia, periosteum or capitellar tendon membrane is mostly used as the repair piece to be sutured. 2, cerebrospinal fluid ear leak repair: the specific site of the ear leak must be identified before surgery. The fracture of the middle cranial fossa involving the tympanic cap causes cerebrospinal fluid to enter the middle ear cavity directly and flow to the external auditory canal through the ruptured ear drum is a vagus external ear leak; the fracture of the posterior cranial fossa involving the vagus causes the subarachnoid cavity to communicate with the middle ear cavity is a vagus internal ear leak, and the two surgical approaches are different. The sutures are usually made of muscle or fascial piece dipped in medical glue, which is then fixed with a tipped muscle cover. After surgery, the scalp layers are tightly sutured without drainage. Postoperatively, intracranial pressure should be reduced and strong antibacterial treatment should be given. 3, cerebrospinal fluid wound leakage (skin leakage): first of all, non-surgical treatment should be carried out carefully, vigorously control infection, and at the same time, outside the wound leakage (>6cm) scalp complete benefit, perform ventricular puncture or perform continuous drainage of the contralateral ventricular puncture, or drainage of cerebrospinal fluid through lumbar puncture tube, adjust the drainage flow to the degree that the leakage mouth stops overflowing, wound leakage if there is no acute inflammation can be cut off the necrotic part of the skin edge and then full suture, if there is acute If there is acute inflammation, the pus and decaying tissue should be removed, and the wound should be closed after the acute inflammation is controlled by suturing again or seed implantation on the granulation surface to destroy the wound.