Diagnosis dan Penatalaksanaan Kebocoran Cairan Serebrospinal

Rahman, Sukri and Edward, Yan and Budiman, Bestari J (2014) Diagnosis dan Penatalaksanaan Kebocoran Cairan Serebrospinal. - . (Unpublished)

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Abstract

ABSTRAK Kebocoran cairan serebrospinal (CSS) terjadi apabila terdapat defek pada tulang dan dura di dasar tengkorak, sehingga menyebabkan hubungan langsung antara ruang subarachnoid dengan ekstrakranial. Kebocoran CSS dapat berupa rinore CSS atau otore CSS, dari berbagai laporan rinore CSS lebih sering terjadi. Kebocoran CSS dapat disebabkan oleh trauma dan nontrauma, namun paling sering akibat trauma dasar tengkorak. Peningkatan angka kejadian trauma kraniofasial yang berat dan pendekatan bedah dasar tengkorak yang semakin agresif telah meningkatkan kejadian kebocoran CSS. Kebocoran CSS berisiko menimbulkan keadaan yang berbahaya akibat infeksi ascending yang dapat menimbulkan meningitis. Diagnosis bertujuan untuk menetapkan adanya kebocoran dan lokasi dari kebocoran CSS. Diagnosis dapat ditegakkan berdasarkan gambaran klinis, pemeriksaan elektroforesis cairan, identifikasi defek pada dasar tengkorak secara visual dan pemeriksaan radiologi. Penatalaksanaan kebocoran CSS bervariasi sesuai dengan etiologi dan lokasinya. Terdapat beberapa pilihan untuk penatalaksanaan berupa observasi, penurunan tekanan intrakranial dan tindakan operasi untuk identifikasi dan penutupan kebocoran. Kata kunci : Kebocoran cairan serebrospinal (CSS), rinore CSS, otore CSS ABSTRACT Cerebrospinal fluid (CSF) leak occurs when there is an osseous and dural defect at the skull base, with direct communication of the subarachnoid space to the extracranial space. CSF leaks are composed of CSF rhinorrhea or otorrhea, CSF rhinorrhea is more common than CSF otorrhea in most reported series. CSF leaks can result from traumatic or nontraumatic in origin, but most CSF leaks are caused by traumatic fractures of the skull base. The increasing number of severe craniofacial injuries and the more aggressive surgical approach to skull base led to an increased number of patients presenting with CSF leak. A CSF leak is potentially very serious because of the risk of an ascending infection which could produce meningitis. The diagnosis is intended to recognize of the extracranial CSF and precise localization of its site of leakage. The diagnosis of a CSF leak is based on the clinical evaluation, the electrophoresis of the drainage, the visual identification of a skull base defect and radiologic findings. The management of CSF leaks varies with etiology and site. Various treatment options are available to manage a CSF leak including observation, decreasing intracranial pressure and surgical identification and closure of the leak. Keywords: Cerebrospinal fluid (CSF) leak, CSF rhinorrhea, CSF otorrhea Kontak: Dr. Sukri Rahman, Sp. THT-KL : sukri_rahman@yahoo.com

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