儿童椎管内脓肿诊治分析及文献复习

目的 提高对儿童椎管内脓肿的早期认识及治疗.方法 回顾性分析河北省儿童医院2015年收治的3例儿童椎管内脓肿患儿的临床资料,结合文献复习,分析其临床特点及诊治方法.结果 3例椎管内脓肿患儿,其中2例位于硬脊膜外,1例位于脊髓内.症状有发热、疼痛、肢体无力、感觉异常及大小便失禁.例1因先天性皮毛窦合并皮样囊肿继发脊髓内感染;例2有外伤病史,考虑血源性感染致硬脊膜外脓肿;例3原因不明,仅术后病理证实为硬脊膜外脓肿.3例患儿手术前后均给予抗生素治疗,并根据病情特点予个体化手术治疗.前2例行术中冲洗,清除脓肿并外引流,例3予完整切除病变并椎管减压,未予引流.其中例2患儿予激素冲击治疗,双下肢无力症状较术前有所改善.经及时治疗,2例硬脊膜外脓肿患儿痊愈出院;脊髓内脓肿患儿好转出院.结论 儿童椎管内脓肿临床少见,病情进展快,提高早期诊断率是提高该病治疗效果的关键;早期个体化手术配合有效、足量、足疗程抗生素治疗效果良好,病情发展至晚期时治疗效果差;激素冲击治疗可短期改善患儿症状.     

先天性背部皮肤窦道与硬脊膜内脓肿

目的：探讨隐性脊柱裂中背部皮肤窦道引起硬脊膜内脓肿原因，以及如何早期诊断，及时治疗。方法：本组6例，年龄1－4岁，均为皮肤窦道伴椎客内皮样囊肿继发脓肿形成，诊断领先临床表现及影像学检查，手术行囊肿剥离及窦道切除，术后随访6－20个月，平均15个月。结果：6例患儿中，3例脊髓发育正常患儿，术后2例神经功能恢复正常，1例明显好转；3例脊髓低和，1例双下肢功能恢复，大小便失禁无明显好转，另2例神经功能无明显改善。结论：先天性脊部皮肤窦道可伴有硬脊膜下或髓内皮样囊肿，并感染形成脓肿，因此，对于中枢感染，应及时检查有否背部皮下窦道以及相应的椎管内病变，以利于及时手术，早期诊断，早期治疗有利于神经功能恢复。     

腰骶部先天性皮肤窦道并中枢神经系统感染的诊疗

先天性皮肤窦道(congenital dermal sinuses,CDS)是由于神经胚发育异常而导致的一种较少见的先天性体表病变.CDS可出现在颅、脊柱轴线的任何区域[1],部分病变与颅内、脊柱椎管内相通,细菌可经此通道逆行引发中枢神经系统感染,出现脊髓内脓肿、脑膜炎、脑脓肿等并发症,严重时危及生命,部分病例治愈后仍较易遗留一定神经障碍,故应重视早期诊断,早期治疗,预防并发症的发生.现报告我科2008年1月至2010年12月确诊的5例腰骶部先天性皮肤窦道并中枢神经系统感染,并对其临床特点及诊断治疗做一相关讨论.     

先天性皮毛窦及其并发症

先天性皮毛窦及其并发症中国医科大学第二临床学院（１１０００３）吴保敏先天性皮毛窦临床上较为少见，其近端常扩张为囊肿压迫神经组织引起脊髓压迫症，其远端皮肤开口处常因逆行感染引起颅内、椎管内感染或开口处出现局部炎症，对小儿健康危害较大。目前本病尚未被同道...     

脊髓表皮样囊肿32例临床分析

总结３２例儿童脊髓表皮样囊肿，并结合文献探讨其形成原因。结果表明，脊柱皮毛窦及复发性脑膜炎为其特征性表现，并可作为诊断依据。患儿多合并脊柱的先天性畸形，圆锥马尾为其好发部位。提示手术切除仍为目前有效的治疗方法，有效率为９０．７％。治疗效果与病程、病变部位无关。     

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脊髓压迫症是指一组具有占位效应的椎管内病变。脊髓由于受到外界的压迫而产生一系列的病理生理变化。脊髓受压后的变化与受压迫的部位、外界压迫的性质及发生的速度有关。一旦外界压迫超过脊髓的代偿能力,脊髓受压症状可进行性加重,最终可造成脊髓水肿、变性、坏死等病理变化,从而导致脊髓功能的丧失,出现受压平面以下的肢体运动、感觉、反射及括约肌功能障碍。脊髓压迫症常见的原因有:椎管内肿瘤、外伤、感染、脊髓血管畸形、椎间盘突出以及先天性脊柱病变等。在儿童则以椎管内肿瘤、外伤、感染和先天性脊柱畸形较为多见。根据临床表现的…     

儿童皮毛窦的诊断及治疗效果分析

目的探讨儿童皮毛窦的诊断方法和手术治疗效果。方法回顾性分析山东大学齐鲁儿童医院2015年1月至2018年6月收治的15例儿童皮毛窦患儿临床资料,所有患儿术前接受MRI检查,且行皮毛窦切除术。结果术前影像学检查发现15例均有皮肤窦道。5例合并皮样囊肿; 2例合并脂肪瘤; 1例合并脊髓纵裂; 1例合并中央管扩大。脊柱三维CT重建检查发现10例合并脊柱裂。术后病理结果均证实为皮毛窦。镜下可见毛发毛干,窦道及其周围组织,炎性肉芽增生组织。所有患儿均获得随访,随访时间6～12个月,术前症状消失或明显改善,窦道未见复发。结论儿童皮毛窦早期诊断及手术治疗有助于改善患儿预后及减少严重并发症的发生。     

小儿阑尾周围脓肿61例临床分析

目的总结19年来北京大学第一医院对于小儿阑尾周围脓肿的治疗经验,探讨治疗策略的变化。方法回顾性分析自1993年至2011年间,作者收治的61例阑尾周围脓肿患儿临床资料。治疗方法包括静脉输入抗生素、理疗、B超引导下脓肿穿刺及手术治疗。结果保守治疗32例,1例于4周后发生肠梗阻,1例1年后再发脓肿;B超引导下行脓肿穿刺4例,无并发症;手术25例（10例行脓肿切开引流并切除阑尾,其余行脓肿切开引流）,出现并发症（切口感染、肠梗阻、残余脓肿）11例。4例于随访期间发作急性阑尾炎,予手术切除阑尾,其中3例存在阑尾粪石。结论对于阑尾周围脓肿,应首选以静脉输入抗生素为主的保守治疗方法;对于部分脓肿较大的患儿,可在B超引导下行穿刺引流。存在阑尾粪石的患儿,应行二期阑尾切除术。     

小儿先天性脐尿管疾病误诊分析

目的 总结脐尿管疾病的临床类型,探讨误诊原因.方法 回顾性分析2001年7月-2008年5月本院外科进行手术治疗的脐尿管疾病住院患儿22例临床资料.结果 按脐尿管闭锁不全情况进行分型,脐尿管瘘13例、脐尿管囊肿4例、脐尿管憩室3例、脐尿管窦2例.术前确诊17例,误诊5例,其中误诊为腹壁肿瘤2例,经手术探查证实为脐尿管囊肿;误诊为阑尾炎并急性腹膜炎3例,经手术探查确诊为脐尿管憩室并局部脓肿.22例均行手术治疗,19例术后恢复良好,3例术后切口感染且与腹膜外腹璧脓肿腔隙相通,经多次换药痊愈.结论 先天性脐尿管疾病腹壁肿块型及急性腹膜炎型易导致误诊.术前对诊断可疑患儿行B超、CT、膀胱镜及静脉尿路造影检查,可提高该病的诊断水平.实用儿科临床杂志,2009,24 (10):795-796     

咽峡炎链球菌群感染患儿119例病例系列报告

目的 探讨咽峡炎链球菌群（SAG）感染患儿的临床特征。方法 回顾性收集2012年1月1日至2019年12月31日首都医科大学附属北京儿童医院细菌培养SAG阳性病例;结合其微生物学、放射学和临床资料对每一分离株进行详细评估,排除SAG阳性为污染和定植菌株。采集病例资料中的发病年龄、性别、临床表现、辅助检查、治疗、转归及预后,菌种鉴定结果及药敏试验。根据病史分为有、无基础疾病2组。基础疾病主要包括先天性心脏病、梨状窝瘘、皮毛窦、先天性食管瘘、先天性胆总管囊肿等先天畸形,免疫抑制,副鼻窦炎,脑性瘫痪,食管异物等。结果 119例感染SAG患儿年龄33 d至16岁,中位年龄4岁（5）;有基础疾病组56例（47.1%）,主要包括头颈部感染27例(48.2%),中枢神经系统感染11例（19.6%）和血流感染10例（17.9%）;头颈部感染中梨状窝瘘19/27例（70.4%）;血流感染中免疫抑制6/10例（60.0%）;中枢神经系统感染中先天性心脏病7/11例（63.6%）,以中间链球菌为主。有、无基础疾病SAG感染患儿,住院天数、热程、外周血WBC计数、中性粒细胞百分比、CRP和血沉差异均无统计学意义。104例(93.7%) SAG感染患儿形成脓肿,头颈部感染41.2%,其次为腹腔感染20.2%、中枢神经系统感染12.6%、血流感染12.6%;咽峡炎链球菌44株,星座链球菌41株,中间链球菌34株。对青霉素、氨苄西林、头孢噻肟、红霉素、克林霉素、万古霉素和利奈唑胺的敏感性分别为87.4%、93.2%、94.2%、20.2%、21.8%、100%和100%。死亡1例,2例因病情危重放弃治疗。结论 SAG感染常形成脓肿,头颈部感染最多见,有、无基础疾病的SAG感染患儿临床特征差异并不明显,中间链球菌是导致脑脓肿的主要SAG病原,SAG菌株对青霉素类抗生素敏感,对大环内酯类抗生素耐药。     

Acute flaccid paralysis in a patient with sacral dimple

Sacral dimples are the most common cutaneous anomaly detected during neonatal spinal examination. Congenital dermal sinus tract, a rare type of spinal dysraphism, occurs along the midline neuraxis from occiput down to the sacral region. It is often diagnosed in the presence of a sacral dimple together with skin signs, local infection, meningitis, abscess, or abnormal neurological examination. We report a case of acute flaccid paralysis with sensory level in a 4 mo old female infant with sacral dimple, diagnosed by magnetic resonance imaging to be a paraspinal subdural abscess. Surgical exploration revealed a congenital dermal sinus tract extending from the subdural abscess down to the sacral dimple and open to the exterior with a minute opening.     

Holocord intramedullary abscess

Intramedullary spinal cord abscess secondary to dorsal dermal sinus is a rare entity and involvement of the entire length of spinal cord is even rarer. A thorough history with precise clinical localization, a high index of suspicion, Magnetic Resonance Imaging (MRI) of spine and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.     

小儿颅脊柱轴先天性皮肤窦道的外科处理

目的总结小儿颅脊柱轴先天性皮肤窦道的临床特点和诊治经验。方法回顾分析1990年7月-2005年7月经外科手术和病理证实43例。结果本组男24例，女19例，年龄2个月～11岁，平均年龄2．6岁。MRI是主要诊断方法。皮肤窦道位于枕后4例．颈段1例，胸段4例，腰骶段34例。枕后4例窦道穿过硬脑膜，合并小脑皮样囊肿继发脑脓肿，脊柱部位39例中合并皮样囊肿20例，表皮样囊肿2例，5例皮样囊肿位于髓内，其中2例继发感染形成脓肿。囊肿完全摘除17例，残留部分囊肿壁5例。结论颅脊柱轴皮肤窦道为先天性疾病。MRI是首选的诊断手段，早期诊断和显微外科手术治疗是最佳的选择。     

A Case of Mixed Bacterial Meningitis Associated with a Congenital Spinal Epidermoid

A case of mixed bacterial meningitis with congenital spinal epidermoid is reported. E. coli and S. faecalis were isolated simultaneously from the cerebrospinal fluid of a 14-month-old girl who had a continuing fever for 5 days. The clinical response was very poor, whereas bacteria detected showed high sensitivity in vitro to the antibiotics used clinically. Thus a myelography and a CT scanning of the lumbosacral region were performed one month after admission, when a spinal epidermoid was forced, containing an abscess connected to a thin dermal sinus which could not be recognized macroscopically. The patient recovered completely after surgical treatment.     

Intramedullary spinal cord abscess: The result of a missed congenital dermal sinus

Congenital dermal sinus (CDS) and occult spinal dysraphism are suspected when a cutaneous marker overlies the spine of a newborn. CDS can have the appearance of a simple dimple and occur within the gluteal cleft without any skin markers. CDS are the commonest cause of intramedullary spinal cord abscess.     

Endogenous foreign body meningitis due to a spinal epidermoid

We present a two year old child with recurrent aseptic meningitis due to a spinal epidermoid in the subdural space. A dermal sinus had been operated earlier in this child. The connection between dermal sinus and spinal epidermoid is demonstrated. Computed tomography (CT) examination should be used as a screening in all patients with congenital dermal sinus with special reference to visualizing anatomical details.     

Dermoid cyst of the posterior fossa associated with congenital dermal sinus in a child

Background  Intracranial dermoid cysts are congenital benign neoplasms. Hydrocephalus and abscess as the principal manifestations of the posterior fossa dermoid cyst are rare. We present a case of obstructive hydrocephalus and abscess induced by an adjacent dermoid cyst with occipital dermal sinus. Methods  A 2-year-old girl presented with headache and vomiting. Physical examination showed nothing abnormal except for a small subcutaneous nodule above the occipital protuberance with a small skin opening. She had no neurological deficits. Neuroradiological studies including CT and MRI showed a cyst located in the posterior fossa. The cyst in the posterior fossa with occipital dermal sinus was diagnosed. She was treated by radical excision of the occipital cyst through a suboccipital approach, and was followed up. Results  Histopathologic examination suggested a dermoid cyst with an abscess. Bacterial investigation revealed Staphylococcus epidermidis, and appropriate systemic antibiotic therapy was given. The child recovered and a 2-year follow-up was uneventful. Conclusions  Posterior fossa dermoid cyst should be considered in all children with occipital skin lesions, especially dermal sinus. CT and MRI scan are helpful in the diagnosis of the lesion. Neurosurgical treatment of the lesion should be planned early to prevent infections such as abscess and meningitis.     

Midline dermal sinuses and cysts and their relationship to the central nervous system.

Sixty-one children (below 12 years) with midline dermal inclusions of the cranium and spine were operated on at the Red Cross War Memorial Children's Hospital between 1969-1990. The bregmatic area was the most common position for superficial cysts (33). Eight children had sinuses or cysts near the external occipital protuberance, 2 had isolated fourth ventricular cysts and 1 had a cyst in the quadrigeminal plate cistern. Fifteen children had spinal dermal inclusions, 13 of these were in the lumbosacral area, there was 1 sinus in the cervical spine and another in the midthoracic area attached to an intramedullary cyst. Two children had frontal sinuses, one of which was connected to an interhemispheric dermoid cyst and a lipoma of the corpus callosum. A midline swelling or sinus was the most common clinical presentation. Four out of 15 spinal inclusions and 1/11 occipital sinuses had a meningitic history. Five of 11 of the posterior fossa inclusions had raised intracranial pressure and signs suggestive of cerebellar tumor or abscess. Not one of the 33 bregmatic lesions had any connection to the central nervous system. MRI has proved useful in diagnosing both dermal sinuses and cysts, but CT scanning was our standard investigation. Plain x-ray revealed bony abnormalities in only 60% of our patients with spinal sinuses. We feel that all dermal sinuses or cysts in the midline should be surgically explored after CT or MRI scanning. Lesions mistaken for bregmatic cysts have included hemangiomas (4), hamartomas (2), an encephalocele through the anterior fontanelle (1) and lipomas (2).(ABSTRACT TRUNCATED AT 250 WORDS)     

Intramedullary spinal immature teratoma: resolution of quadriplegia following resection in a 4-week-old infant

Intramedullary spinal cord teratomas are rare entities in infants. Management of these lesions is primarily surgical, with outcome dependent on rapid surgical decompression and complete gross-total tumor resection. The lesions are typically of the mature type, with immature teratomas displaying unique pathological features. The authors report a case of an extensive intramedullary immature teratoma in an infant with resolution of quadriplegia following gross-total radical resection. At the 1-year follow-up, there was radiographic evidence of tumor, and surgical reexploration yielded portions of immature teratoma and extensive gliosis.