Tailor-made orbitocranioplasty for a sphenorbital encephalocele presenting as pulsatile exophthalmos. Case report.
Tailor-made orbitocranioplasty for a sphenorbital encephalocele presenting as pulsatile exophthalmos. Case report.
复制标题
针对表现为搏动性突眼的蝶眶脑膨出量身定制的眼眶颅骨成形术。
DOI：
10.3171/ped.2007.106.2.126
复制
发表时间：
2007
影响因子：
4.1
通讯作者：
Kazuo Yamada
中科院分区：
文献类型：
--
作者：
H. Katano;N. Aihara;Yotaro Takeuchi;M. Nozaki;Kazuo Yamada
基底部脑膨出仅占所有脑膨出的1.5%。蝶眶型非常罕见，但可引起脑疝入眼眶，导致搏动性眼球突出和视力障碍。作者介绍了一例成功的眶颅成形术治疗蝶眶脑膨出的病例，他们在手术准备中使用了颅骨模型。石膏颅骨模型是从一个6岁的女孩与蝶眶脑膨出获得的三维计算机断层扫描（CT）数据，以确定适当的大小和形状的植入物修复畸形。设计了一种与自体骨具有高亲和力的羟基磷灰石陶瓷植入物，以覆盖缺损，同时扩大眼眶体积并进行刚性固定。术后3D CT扫描显示植入物放置良好，患者的搏动性眼球突出立即消失。患者术后情况良好，术后30个月颅骨成形术周围无神经功能缺损或颅骨畸形。使用3D CT数据的颅骨模型对于确定最合适的重建策略是有用的。羟基磷灰石陶瓷种植体对自体骨有很高的亲和力，因此适合儿童。然而，在这种情况下，应该仔细观察患者，以确保植入物和仍在生长的自体颅骨之间没有不平衡。
Basal encephaloceles account for only 1.5% of all encephaloceles. Within this group, the sphenorbital type is quite rare but causes herniation of the brain into the orbit, leading to pulsatile exophthalmos and disturbance of visual acuity. The authors present a case of successful orbitocranioplasty for a sphenorbital encephalocele in which they used a skull model in preparation for the operation. A plaster skull model was made from 3D computed tomography (CT) data obtained in a 6-year-old girl with a sphenorbital encephalocele to determine the appropriate size and shape of an implant for repair of the malformation. A hydroxyapatite ceramic implant with high affinity to autologous bone was designed to cover the defect and simultaneously to enlarge the volume of the orbit as well as allow rigid fixation. Postoperative 3D CT scanning demonstrated good placement of the implant, and the patient's pulsatile exophthalmos diminished immediately. The patient's postoperative condition has been good, and she has exhibited no neurological deficit or deformity of the skull around the cranioplasty 30 months after the operation. A skull model using 3D CT data is useful for determining the most appropriate strategy for reconstruction. Hydroxyapatite ceramic implants have high affinity to autologous bone and thus are suitable for children. In cases such as the present one, however, the patient should be observed carefully to ensure that there is not an imbalance between the implant and the still growing autologous skull.