Treating Pulsatile Exophthalmos in Child with Minimally Invasive Approach and Custom-made Titanium Mesh Plate
Treating Pulsatile Exophthalmos in Child with Minimally Invasive Approach and Custom-made Titanium Mesh Plate
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微创及定制钛网板治疗小儿搏动性突眼
DOI：
10.1097/gox.0000000000002070
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Okazaki M
中科院分区：
文献类型：
--
作者：
Moriwaki Y;Tomioka Y;Imai H;Iida T;Yamashita S;Kanayama K;Iwamoto N;Okazaki M
眼眶顶骨折是一种相对罕见的创伤。在大多数情况下，由于骨折轻微，因此不需要手术干预。然而，一旦发生搏动性突眼，如果要避免视力损害，侵入性手术是不可避免的。我们报告了一名患有搏动性突眼的儿童发生眼眶顶骨折的罕见经历。使用定制的钛网和微创方法实现了前颅底的良好重建。一名3岁女孩，因面部青肿而被诊断为硬膜下血肿、脑挫裂伤、右眼眶顶骨折，于受伤当天接受了冠状皮肤切口和经颅入路的紧急外部减压。创伤后 103 天，采用相同方法使用自体冷冻骨进行颅骨成形术，但随后出现搏动性突眼。危重期恢复后，女孩被带到我科进行前基底重建。视力受损的风险也是重建的原因之一，但考虑到冷冻自体骨感染的可能性，神经外科医生犹豫是否使用冠状入路接近该区域。经过跨团队讨论，使用定制的钛网板进行眉下切口重建。搏动性突眼完全消失。搏动性突眼是一种非常罕见但严重的并发症，有视力损害的风险。通过应用定制的钛网板，可以实现微创、低风险的精确重建。
Orbital roof fracture is a relatively rare trauma. In most cases, surgical intervention is not needed since the fracture is slight. However, invasive surgical procedures are inevitable once pulsatile exophthalmos occurs if vision impairment is to be avoided. We report our rare experience of orbital roof fracture in a child with pulsatile exophthalmos. Good reconstruction of the anterior cranial base was achieved using a custom-made titanium mesh and a minimally invasive approach. A 3-year-old girl who had been diagnosed with subdural hematoma, brain contusion, and fracture of the right orbital roof caused by facial bruising underwent emergent external decompression by coronal skin incision and a transcranial approach on the same day as the trauma. Cranioplasty using autologous frozen bone in the same approach was performed 103 days posttrauma, but this was followed by pulsatile exophthalmos. After recovering from critical stage, the girl was brought to our department for reconstruction of the anterior base. Risk of vision impairment was also one reason for reconstruction, but the neurosurgeon hesitated to approach the region using a coronal approach considering the possibility of infection in the frozen autologous bone. Through cross-team discussion, reconstruction using a subeyebrow incision was performed with a custom-made titanium mesh plate. Pulsatile exophthalmos completely disappeared. Pulsatile exophthalmos is a very rare but serious complication that carries a risk of vision impairment. By applying a custom-made titanium mesh plate, precise reconstruction was enabled with minimal invasiveness and low risk.
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影响因子：
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作者：
M. Greenwald;G. Lissner;T. Tomita;T. Naidich
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DOI：
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发表时间：
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