Spontaneous meningoencephalocele of the temporal bone - Clinical spectrum and presentation
Spontaneous meningoencephalocele of the temporal bone - Clinical spectrum and presentation
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DOI：
10.1001/archotol.134.5.509
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发表时间：
2008-05-01
影响因子：
--
通讯作者：
Francis, Howard W.
中科院分区：
文献类型：
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作者：
Nahas, Zayna;Tatlipinar, Arzu;Francis, Howard W.
目的：描述自发性颞骨脑膜脑膨出患者的临床表现和影像学及手术结果。设计：回顾性病例系列。设置：学术，三级医疗中心。患者：连续15例经手术证实的乳突和中耳脑膜脑膨出患者，无外伤、肿瘤、中耳瘤或乳突或颅骨手术史，结果：15例患者中有10例为女性。年龄范围为31至77岁，其中12例患者年龄≥ 50岁。最常见的主诉是14例患者的新发听力损失，其次是耳闷和头痛。13例患者的中耳内脑脊液形成积液，最常见于鼓膜切开术导致连续性透明耳孔时。4名受试者有成人发作的复发性急性中耳炎伴间歇性耳漏病史，其中1例并发脑脓肿。在所有病例中，高分辨率计算机断层扫描至少发现1个与中颅窝底皮质变薄相关的被盖全层缺损。手术时，通过1例（7例）或2例（8例）中颅窝底缺损观察到脑膜和脑组织疝出。阻塞窦通气的脑膜脑膨出是目前在所有4例相关的中耳炎。结论：中耳炎的发病，包括中耳积液在40岁或以上，值得考虑的脑膜脑膨出的耳朵。计算机断层扫描显示的被盖缺损和中颅窝底皮质变薄为诊断和手术修复的需要提供了有力的证据。
Objective: To describe the clinical presentation and the radiological and surgical findings in patients with spontaneous meningoencephalocele of the temporal bone.Design: Retrospective case series.Setting: Academic, tertiary care medical center.Patients: Fifteen consecutive patients with surgically confirmed meningoencephalocele of the mastoid and middle ear, without a history of trauma, tumor, cholesteatoma, or surgery of the mastoid or cranium, who were treated at our institution between January 1, 1999, and December 31, 2006.Results: Ten of the 15 patients were women. Ages ranged from 31 to 77 years, with 12 patients 50 years or older. The most common presenting complaint was new-onset hearing loss in 14 patients, followed by aural fullness and headache. Cerebrospinal fluid formed an effusion in the middle ears of 13 patients and was most commonly identified when myringotomy resulted in continuous clear otorrhea. Four subjects had a history of adult-onset recurrent acute otitis media with intermittent otorrhea, which in 1 case was complicated by brain abscess. At least 1 full-thickness defect of the tegmen associated with cortical thinning of the middle fossa floor was identified in all cases on high-resolution computed tomography. At surgery, herniations of meningeal and cerebral tissue were seen through 1 (7 cases) or 2 (8 cases) defects in the middle fossa floor. Obstruction of antral aeration by the meningoencephalocele was present in all 4 cases associated with otitis media.Conclusions: The onset of otitis media, including middle ear effusions at 40 years or older, warrants the consideration of a meningoencephalocele of the ear. The appearance of tegmental defects and cortical thinning of the middle fossa floor on computed tomography provides a strong indication of the diagnosis and of the need for surgical repair.