儿童鼻内型脑膜脑膨出的临床特征及手术治疗

目的探讨儿童鼻内型脑膜脑膨出的临床特征及手术治疗。方法对1995年1月～2005年1月本科收治的9例鼻内型脑膜脑膨出患儿病例资料回顾性分析。结果经颅硬膜外手术4例、硬膜内手术2例，眶上锁孔入路手术3例。9例患儿均1次手术治愈。1例术后出现脑脊液漏，经保守治疗治愈。随访时间6个月～9年4个月，无复发及脑脊液鼻漏、脑膜炎等并发症。结论鼻内型脑膜脑膨出手术的关键是严密的硬脑膜缝合，避免术后脑脊液漏；确凿的颅骨缺损修补，避免术后复发；妥善处理疝囊，改善鼻腔通气功能。经前额入路修补是治疗鼻内型脑膜脑膨出安全有效的手段，眶上锁孔入路手术创伤小，疗效可靠。

The clinical features and treatment of intranasal encephalomeningocele in children

Objective To investigate the clinical features and treatment of intranasal encephalomeningocele in children. Methods Nine children with intranasal encephalomeningocele underwent operations in our hospital between Jan 1995 to Jan 2005 were retrospectively analyzed. Results Transcranial epidural approach was applied to 4 cases, transcranial subdural approach to 2 cases, and supraorbital keyhole approach to 3 cases. Nine patients were successfully treated at initial operation. There was no recurrence, cerebrospinal fluid leakage, and cephalomeningitis during follow-up term from 6 months to 9. 3 years after surgery. Conclusions The key points of operation of intranasal encephalomeningocele include rigorous suture for dura mater, sure restoration for skull defect and appropriate management for hernia sac. Transfrontal approach is an effective and safe method for treatment of intranasal encephalomeningocele in children. The supraorhital keyhole approach is one of ideal approaches in the treatment of intranasal encephalomeningocele in children because it is a minimally invasive method.