MRI在颅底型脑膜脑膨出诊断中的作用

目的 评价MRI诊断颅底型脑膜脑膨出的作用。方法 回顾性分析4例经手术病理证实的脑膜脑膨出病人的临床资料。结果 本组4例均为颅底型，MRI表现为鼻腔内囊状混杂异常信号影，以长Tl长T2脑脊液信号为主，夹杂少量等Tl等T2脑组织信号，病灶包膜完整，上方与前颅窝底蛛网膜下腔相通，增强后无明显强化，其内等T1等T2信号稍强化，并与额叶脑组织相延续，鼻中隔受压弯曲。结论 MRI能正确诊断颅底型脑膜脑膨出，但对颅底骨质缺损显示欠佳。     

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。     

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。     

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。     

鼻内窥镜下经鼻手术治疗先天性脑膜脑膨出

先天性脑膜脑膨出临床比较少见 ,手术治疗是其唯一有效的方法 ,但手术创伤大且常遗留有颅面部畸形而需整形。我科自 1 997年以来经鼻内窥镜下行脑膜脑膨出手术 2例 ,获得较好疗效 ,报告如下。1　病例报告例 1　女 ,1 2岁。因右侧鼻塞反复药物治疗无效于 1 999年 7月入院。鼻镜检查 :鼻腔有光滑肿物 ,质地软 ,蒂位于鼻顶部。穿刺抽出清水样液体 ,糖定量 3.9mmol/L。 CT及 MRI均显示前颅底骨质缺损 (术中证实为 8mm长裂缝 ) ,颅外膨出物中有脑脊液 ,无脑组织。诊断为先天性脑膜膨出 (鼻内型 )。例 2　女 ,1 9岁。因左侧鼻塞在当地医院行“…     

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。     

眶上匙孔入路手术治疗鼻内型脑膜脑膨出

目的 探讨眶上匙孔入路内镜下微创手术治疗鼻内型脑膜脑膨出的可行性及其意义。方法 对1999年1月～2001年12月收治的7例鼻内型脑膜脑膨出患者行眶上匙孔入路内镜下手术治疗。于患侧眉弓内做约3～4cm切口，外侧不超过眉毛，内侧至眶上孔，保留眶上神经血管束，眶上做一直径2．0～2．5cm的圆型骨瓣，抬起额叶，显露颅底骨缺损部位，于缺损处切断疝出物，经鼻内切除。缺损以骨片、筋膜和自体脂肪、耳脑胶修复。结果 7例患者均一次手术治愈，随访6～24个月，均无复发和脑脊液漏发生。结论 眶上匙孔入路内镜下手术治疗鼻内型脑膜脑膨出，安全、有效，创伤小，是治疗鼻内型脑膜脑膨出的较理想入路。     

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 )…     

外伤后迟发性眶内脑膜脑膨出伴脑脊液鼻漏1例

目的探讨外伤后迟发性眶内脑膜脑膨出伴脑脊液鼻漏的临床表现、诊断及治疗方法。方法回顾性分析山西医科大学第一医院2019年8月收治的1例外伤后迟发性眶内脑膜脑膨出伴脑脊液鼻漏患者的临床资料，结合病史及影像学结果明确诊断后，遂在鼻内镜下行脑膜脑膨出修补术，术后给予降颅压、抗炎等治疗。结果患者术后半个月痊愈出院。术后1个月复查，患者头晕、头闷胀感明显好转，左眼球突出较术前缓解，双眼视力无明显变化。结论外伤后发现眶顶骨折缺损后，早期无眶内脑膜脑膨出者，应密切随访及定期复查CT、MRI，以便早发现早治疗。     

自发性颞骨脑膜-脑膨出三例

回顾3例自发性颞骨脑膜-脑膨出患者的临床资料,对其临床表现和治疗进行总结分析。自发性颞骨脑膜-脑膨出的发生与先天性颞骨骨质缺损、肥胖和异位蛛网膜颗粒有关,常以听力下降、耳鸣或原因不明的脑膜炎就诊,颞骨高分辨CT、MRI可辅助诊断。手术是治疗颞骨脑膜-脑膨出的唯一方法,常见的手术入路有经乳突、经颅中窝、经颅中窝联合乳突入...     

CT and MRI and clinical study of chordoma in the skull base]

OBJECTIVE: To investigate the diagnostic features of CT and MRI in chordoma of the skull base (CSB) and to estimate their value of clinical application. METHODS: Sixteen patients with CSB were performed CT and MRI examinations of the head, and 13 patients with nasopharyngeal carcinoma (NPC) and 11 patients with pituitary adenoma (PA) which invaded the skull base were selected as control. In addition, 7 cases of chordoma were performed multiple planar reconstruction (MPR) of MRI. RESULTS: MRI was superior to CT in depicting the location and the extent of CSB. The bone destruction at mid-line skull base was demonstrated equally well on both CT and MRI. Based on the location of the tumor displayed on MRI, the CSB could be classified into selloclival, nasopharyngeal, and occipito-temperal types. The T2 weight imaging(T2WI) signal intensity of chordoma was significantly higher than those of NPC and PA (P < 0.01). On MPR images of MRI, oppressed and displaced optic nerves caused by chordoma were noted in 3 cases and encased optic nerves in 4 cases, encased abducent nerves in 7 cases with abducent paralysis and mildly oppressed oculomotor nerves in 3 cases. CONCLUSION: The extremely high T2WI signal intensity is the characteristic of MRI finding in CSB and has great differential value for the tumors of the skull base. The MPR of MRI plays an important role in the surgical treatment for these tumors.     

颅底脊索瘤的CT和核磁共振成像影像分析

目的研究颅底脊索瘤的CT、核磁共振(magneticresonanceimaging,MRI)诊断特征和临床应用价值.方法16例颅底脊索瘤和侵犯颅底的13例鼻咽癌、11例垂体瘤患者作了头颅CT、MRI检查;7例颅底脊索瘤作了MRI的多层面重建(multipleplanarreconstruction,MPR).结果MRI反映肿瘤的部位和侵犯范围优于CT,CT、MRI显示颅底中线骨质破坏作用相似.根据MRI显示肿瘤的部位与侵犯范围,颅底脊索瘤分为蝶鞍斜坡型、鼻咽型和颞枕型.颅底脊索瘤T2加权(T2weightimaging,T2WI)信号强度明显高于侵犯颅底的鼻咽癌和垂体瘤(P＜0.01).MRI的MPR影像显示,3例视神经被肿瘤推压移位,4例被肿瘤包埋,7例功能损害的外展神经均为肿瘤包绕侵蚀,3例动眼神经受压.结论T2WI显著高信号是颅底脊索瘤的特征性MRI征象,有重要鉴别意义;MRI的MPR技术可对颅神经精确显示,在颅底脊索瘤的手术中有重要应用价值.     

A rare spontaneous temporal meningoencephalocele with dehiscence into the pterygoid fossa

We present an extremely rare case of basal meningoencephalocele that protruded into the left pterygoid fossa from the middle cranial fossa. After a 30-year-old woman experienced a generalized tonic-clonic seizure, computed tomography (CT) scanning showed a large bone defect of the left middle cranial base. A mass lesion with low signal intensity on T1- and high signal intensity on T2-weighted magnetic resonance imaging (MRI) was visualized in the left pterygoid fossa. A biopsy was performed through the transantral approach. Because cerebrospinal fluid (CSF) was observed to flow from the mass lesion, it was diagnosed as a meningoencephalocele. CT showed bone defects in the skull base and a well-circumscribed expansile mass lesion. MRI demonstrated that the brain parenchyma extended into a CSF-filled meningocele. These findings demonstrate that CT and MRI provide adequate information for the diagnosis of meningoencephaloceles.     

侧颅底CT三维重建的临床应用研究

目的探讨ＣＴ三维重建在侧颅底外科的临床应用价值。方法对５例健康成人和１０例侧颅底病变患者（包括颈静脉球瘤３例，听神经瘤２例，颞骨骨折、颞骨骨纤维异常增殖症、颈静脉孔区软骨肉瘤、颈静脉孔区神经鞘瘤、颞骨嗜酸性肉芽肿各１例）在ＰｈｉｌｉｐｓＴｏｍｏｓｃａｎＳＲ７０００全身ＣＴ机上按骨窗条件以１．５ｍｍ层厚连续轴位扫描，扫描范围包括颞骨岩部上面或病变上缘到侧颅底下面骨性标志或病变最下缘。将扫描所获取的原始数据输入ＥａｓｙＶｉｅｗｉｎｇ三维图像工作站进行计算机图像三维重建处理。结果侧颅底ＣＴ三维重建图像能清楚显示正常颅底孔裂和重要的骨性标志、侧颅底病变的范围、颅内外受累情况以及与周围的解剖关系，对于颈静脉孔区病变三维ＣＴ具有鉴别诊断意义，还可模拟手术，帮助手术方案的设计。结论三维ＣＴ在侧颅底外科具有重要的临床应用价值，有利于手术方案的设计。     

侧颅底CT三维重建的临床应用研究

目的 探讨三ＣＴ三维重建在侧颅底外科的临床应用价值。方法 对５例健康成人和１０例侧颅底病变患者（包括颈静脉球瘤３例，听神经瘤２例，颞骨骨折、颞骨骨纤维异常增殖、颈静脉孔区软骨肉瘤、颈静脉孔区神经鞘瘤、颞骨嗜酸性肉芽肿各１例）在ＰｈｉｌｉｐｓＴｏｍｏｓｃａｎＳＲ７０００全身ＣＴ机上按骨窗条件以１．５ｍｍ层厚连续轴位扫描，扫描范围包括颞骨岩部上面或病变上缘到侧颅底下面骨性标志或病变最下缘。将扫描所获取     

颅内三叉神经鞘瘤的CT及MRI诊断

目的分析颅内三叉神经鞘瘤的CT和MRI表现。方法搜集36例经手术和病理证实的颅内三叉神经鞘瘤的CT和MRI资料,探讨颅内三叉神经鞘瘤分型、诊断要点及有关鉴别诊断。结果颅内三叉神经鞘瘤分三型：颅后窝型（8例）、颅中窝型（4例）及骑跨型（24例）。病灶信号混杂,易囊变（12例）,增强后可见不均匀强化;CT能看到岩尖骨质吸收或破坏（17例）。结论CT和MRI的联合应用对三叉神经鞘瘤的定位、定性诊断具有较高的准确性,对临床治疗及手术方式的选择具有指导作用。     

原发性颅底软骨肉瘤CT和MRI诊断

目的分析原发性颅底软骨肉瘤的CT和MRI表现,探讨CT和MRI在颅底软骨肉瘤中的诊断价值。方法搜集经病理组织学证实的9例颅底软骨肉瘤,全部病例均行CT和MRI平扫及增强。结果 9例CT平扫表现为等或略低密度的分叶状或类圆形软组织肿块,伴有不同程度的钙化,且形态不规则,呈散在沙粒样或弧形及粗糙团块状,同时合并骨质破坏;增强后病灶呈非均匀强化。MRI检查T1WI呈等低信号混杂影,T2WI呈高低信号混杂影,肿瘤内钙化在T1WI、T2WI均为无信号区,增强扫描明显不均匀性强化。结论颅底软骨肉瘤有较特有的CT和MRI影像学表现,是诊断颅底软骨肉瘤的有效方法 。     

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.     

Cerebro-spinal fluid otorrhea and a spontaneous defect of the tegmen tympani or antri. A report of 3 cases . Rôle of arachnoid granulations

Less than 150 cases of cerebro-spinal fluid leak with spontaneous defect of the roof of the temporal bone have been described in the international literature. THE AIM OF THIS WORK: Is to define this pathology, to describe the clinical features, to suggest a diagnostic strategy, and to clarify the treatment method and the hypotheses on causation. MATERIALS AND METHODS: This is a retrospective study of 3 cases. RESULTS: At the first medical examination, the most common clinical feature is serous otitis media or otorrhea after myringotomy. Rhinorrhea is rarely pointed out by the patients but exists in our 3 observations. The diagnosis of cerebro-spinal fluid leak with spontaneous defect of the roof of the temporal bone needs; cerebro-spinal fluid leakage, absence of an otologic history or cranial trauma and a bony defect on CT scan. CT scan with millimeter slices is able to show the location and the size of the bony defect(s) of the roof of the temporal bone and often shows partial or total opacity of the middle ear cavities. MRI is able to show if this opacity exists in conjunction with meningeal hernia or cerebro-meningeal hernia. Surgical repair consists of placing an autologous graft over the bony defect by the middle fossa approach. The origin of a spontaneous defect of the temporal bone is discussed. We study the hypothesis in which arachno?d granulations could be responsible for a temporal bone defect.     

Treatment of endonasal-encephalomeningocele by transnasal endoscopic surgery]

OBJECTIVE: To inquire into the feasibility of transnasal endoscopic surgery for endonasal encephalomeningocele, and to put forward the basic management guidelines. METHOD: Five cases of endonasal encephalomeningocele were managed by transnasal endoscopic surgery. Different surgical techniques were applied according to the size and shape of skull base defect. At the same time, one-stage repair of skull base defect was achieved by applying muscle, fascia, cartilage and bone. RESULTS: All 5 patients were successfully treated without complication and relapse during 1-5 year follow-up. CONCLUSION: Endonasal type encephalomeningocele can be managed by transnasal endoscopic surgery. If the skull base defect is less than 0.5 cm, it can be repaired by packing muscle and fascia. If the defect is larger than 0.5 cm, the cartilage or bone should be used to repair the skull base.