LIQUORRHEA (Latin liquor liquid + grech, rhoia the expiration) — the expiration of cerebrospinal liquid from natural foramens of a skull or its defects and a backbone as a result of an injury, inborn uglinesses or new growths of bones of a skull, backbone, head and spinal cord.
Etiology and pathogeny
L. arises in connection with damage of a firm meninx and disturbance of tightness of subarachnoid space (subarachnoidal L.), and also at wound of walls of ventricles (ventricular L.), tanks of a brain (cisternal L.). Sometimes L. arises at defects of closing of an operational wound after interventions on a head and spinal cord (postoperative L.). Distinguish early (primary) L., arising directly after an injury (fig.) or during roughing-out of wounds, and late (secondary) L. — so-called likvorny fistula, to-ry usually develops on 7 — the 12th day after wound as a result inf. complications. Ventricular likvorny fistulas develop in later terms, are characterized by allocation of a large amount of cerebrospinal liquid, strengthening of the expiration of liquid at a prelum of internal jugular veins.
Types of a liquorrhea
the expiration of cerebrospinal liquid from a nose is Most often observed (nasal, or nasal, L.), is more rare from outside acoustical pass (ear L.). It is possible nasal L. through openings of a sievebone in the absence of bone damages because of a separation of fibers of an olfactory nerve. Traumatic nasal L. usually several days last and stops after filling of defect of a firm meninx and a bone with the turned blood, fibrin. However in series of observations it renews at a rassasyvaniye of a blood clot, wrinkling of edematous fabric, especially at increase in intracranial pressure. Ear L. it is observed at damage of a pyramid of a temporal bone, tympanic membrane, often stops spontaneously in the first 2 — 3 days after an injury, remains less often for a long time. The expiration of cerebrospinal liquid usually happens through outside acoustical pass or at the whole tympanic membrane through an acoustical pipe in a nasal part of a throat. The L is rather seldom noted hidden., when cerebrospinal liquid gets into surrounding soft tissues. L. — the terrible complication which is often leading to the ascending infection with development of inflammatory diseases of a brain and its covers.
Diagnosis in most cases does not present difficulties. Blotting of a bandage by watery liquid or its allocation from a wound, a nose, an ear is noted. Difficulties in diagnosis of L. in the acute period of an injury arise when it is combined with bleeding. For differential diagnosis of bleeding and H.p. bleeding offered test on identification of a light rim around a bloody spot on a gauze napkin (positive at L.). In late terms it is necessary to differentiate the expiring cerebrospinal liquid and a serous discharge from a nose at the catarral phenomena and vasculomotor rhinitis. Diagnosis is promoted by a research of allocations from a nose on a sugar content (in serous separated sugar is absent). Helps specification of localization of likvorny fistulas otorinolaringol. a research, a X-ray analysis of a skull, especially a tomography, contrast methods of a research (pneumography), administration of radioisotopes and colorants (indigo carmine, etc.) to the spinal canal with their identification in the nasal courses (at nasal L.).
In the early period of L. the high bed rest is recommended, and in a bed the patient is given such situation that it lost cerebrospinal liquid less. Dehydrational therapy, unloading spinal punctures with endolumbar introduction of 10 — 15 ml of oxygen or air, antibiotics, streptocides are necessary.
At postoperative L., the operational wound caused by defect of closing, imposing of deep skin or musculocutaneous seams on area of infiltration of cerebrospinal liquid with carrying out unloading spinal punctures is recommended. The expiration of cerebrospinal liquid on the course of ligatures is stopped wadded kleolovymi applications. At considerable accumulation of cerebrospinal liquid («a likvorny pillow») in the field of the performed operation repeated punctures in the place of protrusion with aspiration of liquid are recommended. In cases when a wound treat openly, apply long-term bandages with antibiotics, Furacilin, etc. At persistently proceeding L. the positive therapeutic effect is noted at use long (3 — 5 days) a drainage of ventricular system of the brain or spinal subshell space allowing to regulate intracranial pressure. At the likvorny fistulas which are not giving in to conservative treatment an operative measure — avivement in the field of fistula with layer-by-layer careful suture is shown. Chronically current nasal, is more rare ear than L., especially at a recurrence of an inflammation of covers of a brain, demand operational treatment: a craniotomy with sealing of subarachnoid space by closing of defect of a firm meninx and a bone. At impossibility to take in a firm meninx make closing of defect with the stratified leaf of a firm meninx, a musculoaponeurotic rag. Defect of a bone is closed plastic material, at linear fractures of a bone use wax and special glue (see. Cranioplasty ).
Prevention — at the open getting wounds paramount value belongs to early surgical treatment with careful layer-by-layer closing of a wound.
Bibliography: Blagoveshchensk N. S. Combined defeats of frontal sinuses and brain, M., 1972, bibliogr.; Bova E. A. A nasal Liquorrhea at a craniocereberal injury, in book: A severe craniocereberal injury, under the editorship of A. I. Arutyunov and N. D. Leybzon, page 232, M., 1969; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 4, page * 153, M., 1963; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 4, page 432, M., 1950; The Guide to neurotraumatology, under the editorship of A. I. Arutyunov, p.1, page 371, M., 1978; F about h and p-n about D. Lez rhinorrhees et ottorrhees post-traumatiques, Rev. Prat. (Paris), t. 24, p. 2875, 1974; P e r t u i s e t B. e. a. Les rhinorrMas paradoxales par dislocation axia-le traumatique de 1’etage anterieur, Neuro-chirurgie, t. 20, p. 21, 1974; Waller G. Cerebrospinal fluid (Page S. F.) rhinorrhoea without frontobasal fractures, J. Maxillo-fac. Surg., v. 5, p. 54, 1977.
G. A. Pedachenko.