Brain herniation and chronic otitis media: diagnosis and surgical management.
Brain herniation and chronic otitis media: diagnosis and surgical management.
复制标题
脑疝和慢性中耳炎：诊断和手术治疗。
DOI：
10.1046/j.1365-2273.2000.00383.x
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
O. Sterkers
中科院分区：
文献类型：
--
作者：
I. Mosnier;L. E. Fiky;A. Shahidi;O. Sterkers
脑部向中耳内突出是慢性中耳炎的一种罕见但可能危及生命的并发症。1985年至1998年间，我们对50例与慢性中耳炎相关的盖骨缺损患者进行了手术治疗。在这50名患者中，15名患者出现了与骨缺损相关的脑突出症。14例患者曾因慢性中耳炎接受过乳突手术。有5名患者出现神经症状。其中10例在手术前做了磁共振成像(MRI)，可以做出脑突出的诊断。所有患者均采用中颅窝开颅联合经乳突入路修补，其中11例在乳突内有较大的疝和/或炎性组织。全部切除脱出的脑组织，用筋膜和骨封闭硬脑膜和骨缺损处。平均随访2年，无并发症或复发。总而言之，脑突出导致的严重神经系统并发症的发生强调了认识和适当处理这种疾病的必要性。计算机断层扫描(CT)可以怀疑脑突出，但MRI检查最能确定诊断。必要时，应采用中颅窝开颅结合经乳突入路修补腹股沟疝气。
Herniation of the brain into the middle ear is a rare, but potentially life-threatening complication of chronic otitis media. Fifty patients with a tegmen defect associated with chronic otitis media were operated on between 1985 and 1998. Among these 50, 15 patients presented brain herniation associated with the bony defect. Fourteen patients had undergone previous mastoid surgery for chronic otitis media. Neurological symptoms were encountered in five patients. In 10, magnetic resonance imaging (MRI) was performed before surgery, and a diagnosis of brain herniation could be made. The hernia was repaired in all patients using a middle fossa craniotomy, combined with a transmastoid approach in 11 cases where a large hernia, and/or inflammatory tissues were present in the mastoid. The herniated brain tissue was resected in all, and the dural and bony defects were closed with fascia and bone. No complication or recurrence occurred, during a mean follow-up of 2 years. In conclusion, the occurrence of severe neurological complications as a consequence of brain herniation emphasizes the necessity for recognition and appropriate management of this disease. Computerized tomography (CT) scanning allows the suspicion of brain herniation, but a definitive diagnosis can best be established with an MRI study. The hernia should be repaired using a middle fossa craniotomy, combined with a transmastoid approach in one or two stages, when necessary.