TRANSSPHENOIDAL AND TRANSETHMOIDAL ENCEPHALOCELES - A REVIEW OF CLINICAL AND ROENTGEN FEATURES IN 8 CASES
TRANSSPHENOIDAL AND TRANSETHMOIDAL ENCEPHALOCELES - A REVIEW OF CLINICAL AND ROENTGEN FEATURES IN 8 CASES
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DOI：
10.1148/90.3.442
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发表时间：
1968-01-01
期刊：
影响因子：
19.7
通讯作者：
HOYT, WF
中科院分区：
文献类型：
--
作者：
POLLOCK, JA;NEWTON, TH;HOYT, WF
经蝶和经筛窦脑膨出是一种罕见但重要的病变，其引起的症状和体征多种多样，有些具有特征性，有些容易引起误解。他们的诊断，无论是临床和放射学，可能是困难的。在过去，由于未能认识到这些病变而导致手术失误，常常导致脑膜炎和死亡。我们在此报告3例经筛窦脑膨出和5例经蝶窦脑膨出的临床和神经放射学观察。8例患者中有6例在加州大学医院接受研究。基底脑膨出的发病率在他们的546例脊柱裂和颅骨裂的系列研究中，英格拉哈姆和Swan（16）发现了84例脑膨出。这一数字占所有脑疝、脊髓疝或脑膜疝的15%。大约75%的脑膨出发生在枕骨区，10%发生在顶骨区。其余15%为累及鼻额部或额部的前部脑膨出，其中仅一例为先天性脑膨出，这也是本报告的主题。这可能是一个隐匿性鼻内（经筛窦）脑膨出。因此，84例中最多有1例为经筛窦型，发生率低于1.5%，经蝶窦型极为罕见，我们以前仅发现6例（7，15，19-21，30）.基底脑膨出的解剖学分类根据Meyer（1890）的方案，对颅骨额部和基底部的脑膨出进行解剖学分类。（24），Safranek（1926）（29），和Gisselsson（1947）（13）。基底型脑膨出是发生于沿着筛板或穿过蝶骨。肿块可能出现在鼻腔、鼻咽、上咽、蝶窦、后眼眶或翼腭窝。与其他类型的重要区别是，除了罕见的疝出如此之大，以至于它们从口腔或鼻孔突出外，没有可见的外部肿瘤（21，31）。基底部脑膨出的不同类型如下：蝶咽部：蝶骨存在缺损，脑膨出通常延伸到下咽部。它可能只延伸到蝶窦（4），然而，因此，经蝶型的命名是更合适的。蝶眶型：这种类型的脑膨出穿过上级眶裂位于地球仪的后面，并导致单侧眼球突出。这种类型的脑膨出，虽然以前报告（3，25，27），没有发现在这个系列。大多数在这个位置的脑膨出似乎与骨缺损有关，而不是通过正常的椎间孔疝出。
Transsphenoidaland transethmoidal encephaloceles are rare but important lesions that cause various signs and symptoms, some characteristic and some misleading. Their diagnosis, both clinical and radiologic, may be difficult. Failure to recognize these lesions has in the past led to surgical misadventure, often resulting in meningitis and death.We report here clinical and neuro-radiologic observations in 3 cases of transethmoidal encephalocele and in 5 of transsphenoidal encephalocele. Six of the 8 patients were studied at the University of California Hospital.Incidence of Basal EncephalocelesIn their series of 546 cases of spina bifida and cranium bifidum, Ingraham and Swan (16) noted 84 encephaloceles. This figure represented an incidence of 15 per cent of all herniations involving the brain, spinal cord, or meninges. About 75 per cent of these encephaloceles were in the occipital area and 10 per cent in the parietal area. Anterior encephaloceles involving the nasofrontal or frontal area of the skull comprised the remaining 15 per cent. In only one of their patients was the congenital lesion which is the subject of this report exemplified. It was probably an occult intranasal (transethmoidal) encephalocele. At most, therefore, 1 of 84 cases was transethmoidal, suggesting an incidence of less than 1.5 per cent. The transsphenoidal type is extremely rare, and we found only 6 cases reported previously (7, 15, 19–21, 30).Anatomic Classification of Basal EncephalocelesEncephaloceles in the frontal and basal portions of the skull are classified anatomically according to the scheme of Meyer (1890) (24), Safranek (1926) (29), and Gisselsson (1947) (13).The basal type of encephalocele is that which occurs along the cribriform plate or through the sphenoid bone. The mass may appear in the nasal cavity, nasopharynx, epipharynx, sphenoid sinus, posterior orbit, or pterygopalatine fossa. The important distinction from other types is that no external tumor is visible except in those rare instances of herniations so large that they protrude through the mouth or nares (21, 31). The different types of basal encephalocele are as follows:Sphenopharyngeal:A defect exists in the sphenoid bone, and the encephalocele usually extends into the epipharynx. It may extend only into the sphenoid sinus (4), however, and therefore the designation of transsphenoidal type is more appropriate.Sphene-orbital:This type of encephalocele passes through the superior orbital fissure to lie posterior to the globe and results in unilateral exophthalmos. This type of encephalocele, although previously reported (3, 25, 27), was not found in this series. Most of the encephaloceles in this location appear to be associated with an osseous defect rather than with herniations through the normal foramina.