婴幼儿先天性基底型脑膜脑膨出的诊断及鼻内镜手术治疗

目的 探讨婴幼儿先天性基底型脑膜脑膨出的诊断及鼻内镜手术治疗的安全性和有效性.方法 回顾性分析8例婴幼儿先天性基底型脑膜脑膨出的临床资料.术前进行鼻窦CT和MRI检查,全部病例经鼻内镜下脑膜脑膨出切除术及颅底修复重建术,术后随访手术疗效.结果 8例病例包括经筛型6例、蝶咽型2例.手术均一次性成功,无并发症出现.术后随访...     

小儿先天性鼻腔鼻窦肿物的临床诊疗观察

目的 探讨小儿先天性鼻腔鼻窦肿物的诊断及鼻内镜手术治疗的安全性和有效性.方法 回顾性分析上海交通大学医学院附属新华医院收治的24例先天性鼻腔鼻窦肿物患儿的临床资料.术前进行鼻内镜、鼻窦CT和MRI检查,全部病例经鼻内镜下鼻腔鼻窦肿物切除术,术后随访手术疗效.结果 24例中良性占位17例,其中脑膜脑膨出8例、骨化纤维瘤3...     

先天性鼻内脑膜脑膨出合并异位神经胶质瘤（附1例报道并文献复习）

 目的探讨先天性鼻部脑膜脑膨出合并鼻外神经胶质瘤的诊断和治疗。方法收集上海交通大学医学院附属第九人民医院收治的1例鼻内脑膜脑膨出合并鼻外神经胶质瘤患儿,并结合文献进行复习。入院后行鼻腔鼻窦CT扫描及头颅MRI,根据影像学检查结果制定手术方案,在全麻下行鼻内镜下鼻腔肿物切除术及颅底骨质缺损修补术联合鼻外径路外鼻肿物切除术,术后予应用透过血脑屏障的抗炎治疗。结果鼻根部及鼻腔肿块一次性切除,愈合良好,无脑脊液鼻漏、脑膜炎、鼻中隔穿孔、视力障碍及癫痫等并发症,随访1年无复发。术后病检提示鼻根部及鼻腔内送检肿物见神经胶质细胞,考虑为异位神经胶质瘤和脑膜脑膨出。结论对于婴幼儿先天性鼻部脑膜脑膨出,鼻腔鼻窦CT及头颅增强MRI是重要的诊断依据,根据病变部位制定不同的手术的方式。鼻内镜具有视野清晰、损伤小、出血少、并发症少的优点。颅底骨质缺损修补的关键是根据骨缺损面积,予肌肉、筋膜、软骨瓣或骨片填塞漏口。     

经鼻内镜治疗儿童脑膜脑膨出

目的:探讨鼻内型儿童脑膜脑膨出的诊断和鼻内镜微创外科治疗的方法。方法:2例均经CT和MRI确诊。在鼻内镜或耳内镜下,经鼻吸出膨出于鼻腔的脑膜组织,判断缺损位置和范围,取同侧大腿外肌肉和筋膜封堵颅底。结果:2例均经1次手术治愈,术后随访1~2年未见复发,无其他并发症。结论:CT和MRI在诊断鼻内型脑膜脑膨出具有重要价值。鼻内型脑膜脑膨出可选择经鼻内镜的鼻内进路手术方式,鼻内镜下经鼻进路手术修补鼻内型脑膜脑膨出具有安全、简便、损伤小、并发症少等优点。     

婴幼儿鼻腔先天性占位的诊断及鼻内镜手术治疗

目的 探讨婴幼儿鼻腔先天性占位的诊断与鼻内镜手术治疗。方法 总结分析12例婴幼儿鼻腔先天性占位的临床表现、鼻内镜检查、CT及MRI影像学及术中表现。结果 脑膜脑膨出3例,神经胶质瘤1例,错构瘤3例,畸胎瘤1例,血管瘤3例,胚胎性横纹肌肉瘤1例。结论 婴幼儿鼻腔先天性占位良性多见,治疗以手术完全切除为主,术前鼻内镜检查、增强薄层CT及增强MRI影像学检查对术前诊断、手术方式选择和手术风险评估十分必要。鼻内镜手术可以完全切除大多数病变,并且具有创伤小、视野清晰等优点。     

外伤性脑膜脑膨出诊断与经鼻内镜手术

目的:报告5例外伤性脑膜脑膨出脑脊液鼻漏的经鼻内镜下手术治疗结果,探讨诊断和手术方法。材料和方法:1998年9月至2002年3月诊断为外伤性脑膜脑膨出并行鼻内镜手术修补的5例患者病例资料,脑膜脑膨出定性和脑脊液漏出部位的定位诊断主要依靠高分辨鼻窦CT扫描、MRI检查和MR和CT脑池造影。结果:蝶筛交界处顶壁膨出1例,左侧筛窦顶壁中部膨出1例,右侧蝶窦外侧壁膨出,筛板中后部有2处脑脊液信号与鼻腔通1例,右侧额窦后壁近额窦底膨出,伴发鼻窦炎l例,右侧筛窦顶壁前部膨出1例。手术一期修补成功,随访4～38个月。无手术中和手术后并发症。结论:脑膜脑组织膨出和脑脊液漏出位置的确定可依靠MR和CT脑池造影等,首选CT脑池造影;内镜下经鼻切除膨出脑膜组织并修补颅底安全精确,镜下手术处理膨出脑组织的关键要使用双极电凝器。     

外伤性脑膜脑膨出诊断与经鼻内镜手术

目的：报告5例外伤性脑膜脑膨出脑脊液鼻漏的经鼻内镜下手术治疗结果，探讨诊断和手术方法。材料和方法：1998年9月至2002年3月诊断为外伤性脑膜脑膨出并行鼻内镜手术修补的5例患者病例资料，脑膜脑膨出定性和脑脊液漏出部位的定位诊断主要依靠高分辨鼻窦cT扫描、MRI检查和MR和CT脑池造影。结果：蝶筛交界处顶壁膨出1例，左侧筛窦顶壁中部膨出1例，右侧蝶窦外侧壁膨出，筛板中后部有2处脑脊液信号与鼻腔通1例，右侧额窦后壁近额窦底膨出，伴发鼻窦炎1例，右侧筛窦顶壁前部膨出1例。手术一期修补成功，随访4～38个月。无手术中和手术后并发症。结论：脑膜脑组织膨出和脑脊液漏出位置的确定可依靠MR和CT脑池造影等，首选CT脑池造影；内镜下经鼻切除膨出脑膜组织并修补颅底安全精确，镜下手术处理膨出脑组织的关键要使用双极电凝器。     

CT和MRI在诊断鼻内型脑膜脑膨出中的作用

目的：评价CT和MRI在诊断鼻内型脑膜脑膨出中的价值。方法：回顾性分析7例经手术和病理证实鼻内型脑膜脑膨出患者的CT与MRI表现；4例均行CT和MRI扫描,2例仅行CT扫描，1例仅行MRI检查。结果：7例鼻内型脑膜脑膨出患者中有1例并发脑积水。冠状位CT扫描可见筛骨骨质缺损，MRI见鼻腔内囊状异常脑脊液信号，并向上与颅内蛛网膜下腔直接相通，其内有少量脑组织信号。结论：CT和MRI能正确诊断该型脑膜或脑膜脑膨出；CT显示颅底骨质缺损大小、部位优于MRI，MRI可清楚显示疝出物及其与脑底的关系。     

脑膜脑膨出鼻内镜外科治疗

目的 总结鼻内镜手术治疗颅底脑膜脑膨出的方法 和临床经验.方法 运用内镜经鼻外科手术治疗鼻部脑膜脑膨出9例,采用自体阔肌筋膜片修补颅底缺损.结果 9例患者中,8例1次手术治愈,随访1～4年无复发.中位随访时间2年.1例复发,于术后1个月出现脑脊液鼻漏,再次手术以阔肌筋膜+人工脑膜修复,术后随访1年半未复发.术后并发症包括发热1例、脑脊液鼻漏1例,全部病例无颅内感染、颅内出血、脑水肿及脑积水等其他并发症.结论 内镜经鼻治疗颅底脑膜脑膨出不仅微创、安全,而且视野清晰,可更好地辨认漏口及其周围结构,是治疗鼻部脑膜脑膨出的首选手术方法 .准确定位漏孔,选用合适的修复材料及技术是手术成功的关键.     

经鼻内镜治疗鼻内型先天性脑膜脑膨出二例

先天性鼻部脑膜脑膨出临床少见 ,分为额筛型和基底型 ,基底型称为鼻内型。现将我科治疗 2例报告如下。例 1　男 ,4岁。因左侧鼻塞 3岁时在当地医院行“左侧鼻息肉摘除术” ,术后左侧鼻腔通气好转 ,但左鼻流清水样鼻涕 ,无头痛及发热 ,因 1个月来左侧鼻塞加重 ,清涕增多于2 0 0 0年 11月入院。查体 :外鼻无畸形 ,左侧鼻腔内见淡蓝色半透明肿物 ,触之有囊性感 ,不出血 ,蒂部窥不清。鼻腔分泌物糖定量 4 1mmol/L ,CT及磁共振成像 (magneticresonanceimaging ,MRI)均示前颅底骨质缺损 ,脑组织突入鼻腔。入院诊断为先天性脑膜脑膨出 (鼻内型 )…     

孤立性蝶窦疾病的诊断及其鼻内镜手术治疗

目的：探讨孤立性蝶窦疾病的临床特点、影像学特征和鼻内镜手术的疗效。方法：38例孤立性蝶窦疾病患者,35例行鼻窦CT（其中5例同时行MRI）,3例行单纯鼻窦MRI,1例行脑池CT造影。所有患者均行鼻内镜下蝶窦开放术,其中有33例采用经鼻腔嗅裂径路,5例采用经前筛一后筛径路（即Messerklinger技术）。结果：术后随访6个月以上,34例病情完全控制,4例部分控制。术中和术后均未出现严重并发症。结论：孤立性蝶窦疾病临床症状不典型,无特异性,鼻部检查多无阳性体征,仅有以头痛为主诉的神经系统症状,早期常难以确诊。鼻窦CT和MRI是诊断孤立性蝶窦炎的最佳手段,而鼻内镜手术则是治疗该病的首选方法。     

Nasal glial heterotopia: embryological and clinical approaches

INTRODUCTION: Nasal gliomas or heterotopia are nonhereditary congenital malformations composed of heterotopic neuroglial tissue. They usually present in infancy. Evaluation should include preoperative imaging with CT scan and/or MRI to rule out intracranial extension. There have been several cases reported in which nasal gliomas were misdiagnosed as capillary hemangiomas. The differential diagnosis includes prenasal space developmental impairment, which are nasoethmoidal meningoencephaloceles, nasal dermoid and epidermoid cysts. CASE REPORT: We describe the case of a newborn male infant presenting at birth with a paramedial nasal glioma. An embryological and clinical analysis of nasal gliomas is proposed. DISCUSSION: Nasal glioma is an uncommon congenital lesion presenting as a large panel of midline craniofacial anomalies. The embryological and anatomical origins of nasal gliomas are reviewed. The most known embryological theory was described by Grünwald in 1910 and is called the "prenasal space" theory. This theory is very attractive because of the embryopathogenic continuum proposed among dermoids, gliomas, and encephaloceles. In this article, we discuss major embryological theories on nasal gliomas pathogenesis and propose that while the prenasal space theory can explain the occurrence and the continuum between basal anterior or prenasal encephaloceles and gliomas, it cannot explain the occurrence of craniofacial demoids of the same topography. Better knowledge of embryological mechanisms implicated in the pathogenesis of nasal gliomas can help clinical management of this kind of malformations.     

开放性鼻整形切口治疗儿童先天性鼻中线囊肿及瘘管4例及文献复习

目的 探讨开放性鼻整形切口在治疗儿童先天性鼻中线囊肿及瘘管的手术适应证及预后.方法 回顾分析4例先天性鼻中线囊肿及瘘管的儿童[男3例,女1例,2～6岁(平均4岁)]的临床资料、影像学资料、治疗效果及预后情况,所有患儿均在接受全身麻醉下开放性鼻整形切口入路切除病灶,术后规律随访,随访参数包括病灶复发情况、切口瘢痕情况、鼻...     

Evolutions in the management of congenital intranasal skull base defects

BACKGROUND: Congenital skull base defects have traditionally been treated via an intracranial approach. Recent advances in endoscopic management have made minimally invasive extracranial approaches feasible, with less morbidity. OBJECTIVE: To determine the success of endoscopic treatment of congenital cerebrospinal fluid leaks and encephaloceles. MAIN OUTCOME MEASURES: Retrospective review of congenital cerebrospinal fluid leaks and encephaloceles treated from January 1, 1992, to December 31, 2003. Data collected include demographic characteristics, presenting signs/symptoms, site of the skull base defect, surgical approach, repair technique, and clinical follow-up. RESULTS: Eight patients were treated via the endoscopic approach for congenital cerebrospinal fluid leaks and encephaloceles. The average age at presentation was 6 years (range, birth to 18 years). Three patients presented with meningitis (average age, 6 years), 4 had cerebrospinal fluid rhinorrhea, and 3 developed a nasal obstruction. Five defects originated at the foramen cecum, and 3 others involved the ethmoid roof/cribriform plate only. Our endoscopic approaches were successful on the first attempt, with a mean follow-up of 19 months. One patient experienced nasal stenosis postoperatively. CONCLUSIONS: Continuing progress in the surgical management of congenital skull base defects demonstrates that endoscopic repair is a successful alternative to traditional craniotomy approaches, with less morbidity. This technique requires meticulous preparation and precise grafting of the defect to avoid collateral damage to surrounding structures. While reduction in the risk of meningitis, intracranial complications, and facial growth abnormalities and alleviation of nasal obstruction necessitate the timely repair of these skull base defects, special considerations are discussed regarding the optimal timing of surgical intervention, operative working space, and exposure in a smaller nasal cavity.     

鼻内翻性乳头状瘤的术式选择和疗效分析

目的 探讨鼻内翻性乳头状瘤(NIP)的手术治疗策略及相应疗效情况。 方法 回顾性分析2010年10月至2016年10月收治的181例NIP患者的临床资料。患者术前均行鼻内镜、CT或MRI检查,明确病变范围,根据Krouse分期系统进行临床评级,综合评估并制定手术方法,其中鼻内镜手术124例,鼻侧切开术27例,鼻内镜联合柯-陆式手术30例。术后随访1~6年。 结果 181例NIP患者术后总复发率为17.7%(32/181),其中鼻内镜手术复发率为15.3%(19/124),鼻侧切开术复发率为25.9%(7/27),鼻内镜联合柯-陆式手术复发率为20.0%(6/30),差异无统计学意义(P>0.05)。对不同分级患者术后复发率进行统计,其中Ⅰ级复发率为11.8%(2/17),Ⅱ级复发率为11.6%(8/69),Ⅲ级复发率为17.2%(11/64),Ⅳ级复发率为35.5%(11/31),级别越高复发率相对越高;各级之间术后复发率差异有统计学意义(P<0.05)。 结论 鼻内镜手术已成为NIP主要治疗方式,疗效与鼻外径路术式相仿。高分级NIP复发率较高,而合理选择术式彻底切除肿瘤及严格的术后随访则是其治疗成功的关键。     

Nasal encephalocele: differential diagnosis with nasal glioma

Congenital nose neoplasms are infrequent, between them neurogenic tumors of the middle line include nasal gliomata (glial ectopies) and nasal encephaloceles, according to an existing or lacking communicating link with the intracranial cavity. We report one congenital naso-encephalocele case in a 16-year-old girl suffering from repeated meningitis events after several nasal polypectomies performed in other departments. She underwent complete removal through fronto-neurosurgical and paralateronasal approach, being the young woman asymptomatic for 3 years. We discuss about both intranasal gliomata and encephaloceles, certainly of not easy pathologic identification, stressing the decisive value of imaging techniques, as magnetic resonance, in order to clearcut both the diagnosis and the therapeutical planning.