Diagnostik und Therapie von frontobasalen Liquorfisteln

Zusammenfassung

Die frontobasale Liquorfistel ist unabhängig von ihrer Genese durch eine offene Verbindung des Liquorsystems mit der Außenwelt (normalerweise der Nase und den Nasennebenhöhlen) gekennzeichnet. Sie führt zu einem Verlust von Liquor cerebrospinalis und ist mit einem erheblichen Risiko für den Patienten verbunden, im Laufe seines Lebens an einer Meningitis zu erkranken. Die genaue Kenntnis der möglichen Ursachen, klinischen Symptome und aktuellen Konzepte in Diagnostik und Therapie sind essenziell für die Erkennung von frontobasalen Liquorfisteln durch den HNO-Arzt und die Voraussetzung für ein erfolgreiches Therapiemanagement. Der vorliegende Artikel gibt eine Übersicht über Ätiologie und klinische Zeichen einer frontobasalen Liquorfistel. Des Weiteren werden qualitative Nachweismethoden, die in der Liquordiagnostik bei der Analyse von aufgefangenen Flüssigkeiten zur Anwendung kommen, und radiologische sowie endoskopische Verfahren zur Lokalisation von Liquorfisteln vorgestellt. Schließlich werden die endonasalen chirurgischen Techniken der frontobasalen Liquorfistel erläutert.

Abstract

Independent of its origin a frontobasal cerebrospinal fl uid (CSF) fi stula is characterized by an open connection between the intracranial space with the outside world (usually the nose and paranasal sinuses). It leads to loss of CSF and is associated with a signifi cant risk of developing meningitis for the patient during further life. Precise knowledge of possible aetiologies, clinical symptoms, current diagnostic options and surgical strategies are essential for the detection and successful management of frontobasal CSF fi stulas. This article summarizes aetiology and clinical signs of frontobasal CSF fi stulas. Further, laboratory tests to analyse fl uid samples for cerebrospinal fl uid as well as radiological and endoscopic investigation methods aiming to localize a CSF-fi stula are presented. Finally, surgical techniques to close a frontobasal CSF fi stula are explained.

Schlüsselwörter

Rhinoliquorrhoe - Liquorfistel - Beta-2-Transferrin - Beta-Trace-Protein - Fluoreszein - Duraplastik - endoskopische Chirurgie

Key words

rhinorrhea - cerebrospinal fluid fistula - beta-2-transferrin - beta-trace-protein - fluorescein - duraplasty - endoscopic surgery

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