慢性中耳炎的HRCT诊断

探讨慢性中耳炎的ＨＲＣＴ征象，诊断及鉴别诊断。材料与方法；对手术证实的１７例慢性中耳炎患者术前进行ＨＲＣＴ扫描并与手术病理结果对照分析。结果；胆脂瘤８例表现为中耳腔内团块状影，周围低密度环包绕，听骨明显破坏及鬓 扩大，骨缘硬化。４例肉芽肿多呈片状，条索状或网状，听骨破坏较轻。     

颅底胆脂瘤的MRI特征

目的探讨颅底胆脂瘤MRI分型的意义及其MRI诊断特征。方法观察15例颅底胆脂瘤的CT、MRI与病理学资料，根据肿瘤T1WI信号的不同，将颅底胆脂瘤分为Ⅰ型和Ⅱ型，分析两型胆脂瘤在CT、MRI征象和颅底骨质侵犯等方面的差异。结果15例颅底胆脂瘤T2WI显著高信号，肿瘤实质无强化。15例中，Ⅰ型，6例，肿瘤位于桥前池和桥小脑角区，CT均匀低密度，T1WI均匀低信号，包膜不强化，颅底骨质改变轻微，肿瘤实质为胆固醇结晶；Ⅱ型，9例，肿瘤位于一侧中、后颅窝底，CT呈混杂密度，T1WI呈混杂信号，其中4例为低信号中夹杂少量高信号，另5例以高信号为主，包膜强化，颅底骨质呈显著外压性改变，肿瘤实质为角化上皮和蛋白。结论颅底胆脂瘤分为Ⅰ型和Ⅱ型是合理的，体现了两型颅底胆脂瘤组织病理和生物学行为的差异，对指导MRI诊断有积极意义。T1WI信号多样性、T1WI显著高信号、肿瘤实质不强化以及与MRI分型相关的颅底骨质侵犯是颅底胆脂瘤的MRI诊断特征。     

蒲氏间隙的高分辨率CT测量

目的:在HRCT图像上测量正常成人蒲氏间隙(Prussak space)的宽度,为胆脂瘤早期诊断提供参考。材料和方法:60例正常成人耳部(男性和女性各30例)做冠状位HRCT扫描,测量锤骨颈外缘至鼓室盾板尖端的距离(相当于蒲氏间隙宽度),并作统计学分析。结果:测量值在1-1.5mm之间,平均1.22±0.098mm。平均值分别为:男性左耳1.193±0.021mm;男性右耳1.227±0.019mm;女性左耳1.213±0.016mm;女性右耳1.233±0.015mm,统计分析显示男女之间和左右耳之间均无明显差异(t=0.255,t=1.137和t=0.845,均P>0.05)。结论:正常成人蒲氏间隙宽度在HRCT图像上约为1-1.5mm,性别与双耳之间无明显差异,此间隙宽度>1.5mm可作为诊断上鼓室胆脂瘤的一个重要依据。     

Intracranial Extension of Acquired Aural Cholesteatoma

Objective Cholesteatoma of the petrous bone extending into the intracranial region is an unusual occurrence. Most cases have been attributed to secondary extension of a primary epidermal blastomatous malformation of the temporal bone into the middle or posterior fossae. Within the past two and a half decades, intracranial extension of acquired aural cholesteatoma has been recognized as a likely alternative to this mechanism. Recent literature has rejoined this observation by considering both primary and secondary cholesteatoma of the petrous bone as a single group, petrosal cholesteatoma. The present study is presented to analyze the clinical presentation, imaging findings, and surgical treatment of six patients with acquired aural cholesteatoma extending into the intracranial region. Findings in this study are compared with the extant literature on congenital and acquired cholesteatoma of the petrous bone. This study proposes that petrosal cholesteatoma is a valid anatomical construct; however, the pathogenesis of petrosal cholesteatoma is still important in understanding the clinical presentation and management of cholesteatoma that extends beyond the usual confines of the middle ear and mastoid. Study Design Retrospective case review conducted at a tertiary referral center. Methods From 1985 to 1999, 477 patients were surgically treated for acquired aural cholesteatoma. Patients with intracranial extension of cholesteatoma were studied. Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated. Results Six cases in a series of 477 patients with acquired aural cholesteatoma had intracranial extension of disease. In this series, the most frequent pathway for intracranial extension was supralabyrinthine through the supratubal recess into the middle cranial fossa. A less frequent pathway was via the retrofacial air cells into the posterior cranial fossa. Surgical access for removal of intracranial cholesteatoma was accomplished through several approaches including translabyrinthine, transcochlear, retrolabyrinthine, and middle cranial fossa. In two patients who had reoperation for possible residual disease, one was free of residual disease and one was found to have residual cholesteatoma in the region of the horizontal facial nerve. Conclusion Acquired aural cholesteatoma can extend into either the middle or posterior cranial fossae. In this study, cholesteatoma extended into the middle fossa through the supratubal recess along the labyrinthine facial nerve and into or above the internal auditory canal. A less frequent path is through the retrofacial air cells into the posterior fossa. Intracranial acquired cholesteatoma is generally small and presents with complaints related to underlying otitis media rather than the neurological deficits that are often associated with primary petrous bone cholesteatoma. While computed tomography and magnetic resonance imaging are both required to differentiate congenital petrous cholesteatoma from other lesions of the petrous bone, computed tomography of the temporal bone is usually sufficient to diagnosis and define intracranial extension of acquired aural cholesteatoma. These lesions can be completely excised rather than exteriorized.     

人乳头状瘤病毒及其相关基因在中耳胆脂瘤中的表达

目的　探讨人乳头状瘤病毒 (humanpapillomavirus ,HPV)感染在中耳胆脂瘤发生发展中的作用。方法　运用共同引物聚合酶链反应 (polymerasechainreaction ,PCR)和核酸分子斑点杂交法对44例 ( 44耳 )中耳胆脂瘤标本组织中的HPVDNA进行检测 ,并结合其中 35例 ( 35耳 )的病理学检查结果进行对比分析。结果　 12耳 ( 34.3 % )中耳胆脂瘤组织中观察到了HPV感染的损害特征 ;用共同引物PCR法及核酸分子斑点杂交法对 44耳中耳胆脂瘤组织标本进行HPVDNA扩增的阳性率分别为2 9 .5 % ( 13 44 )及 2 5 .0 % ( 11 44 ) ;表现有人乳头瘤病毒损害特征的 12耳中耳胆脂瘤组织HPVDNA检测阳性率为 5 8.3% ( 7 12 ) ,而无此损害特征的 2 3耳中耳胆脂瘤组织HPVDNA检测阳性率为 13.0 %( 3 2 3) ,统计学检验差异有显著性 ( χ2 =7.92 6 ,P <0 .0 0 5 )。结论　HPV感染可能激发中耳胆脂瘤上皮的分裂增殖 ,在中耳胆脂瘤发生发展中起一定的作用 ;侵蚀性乳头瘤样生长和空晕细胞改变可以作为中耳胆脂瘤组织中HPV感染的病理学证据     

肿瘤坏死因子-α在中耳胆脂瘤中的表达及其意义

目的 :探讨肿瘤坏死因子 -α(TNF-α)在中耳胆脂瘤中的表达和引起骨吸收的作用机制。方法 :应用 TNF-α单克隆抗体对 18例中耳胆脂瘤组织和 4例正常外耳道皮肤 ,4例面部皮肤和鼓膜进行免疫组化测定。结果 :TNF-α在胆脂瘤组织上皮及上皮下结缔组织的表达较正常外耳道皮肤及鼓膜的染色强的多。结论 :TNF-α细胞因子在中耳胆脂瘤组织中有较高表达 ,这种细胞因子可能通过两条途径引起骨质吸收 :直接途径 ,TNF-α作为自分泌调节因子引起破骨性骨吸收 ;间接途径 ,作为中间信使激活炎性细胞释放一系列生物酶引起骨组织脱钙 ,骨基质和骨蛋白溶解 ,最终导致骨吸收     

Immunohistochemical demonstration of c-myc oncogene product in middle ear cholesteatoma

Cholesteatoma epithelium is characterized by a dysregulation with a hyperproliferative growth and altered differentiation. In a variety of cells c-myc oncogene was found to be highly linked to the control of growth and differentiation. Expression of c-myc was studied in cholesteatoma epithelium using a monoclonal antibody directed against the 67 kDa c-myc protein product and the alkaline phosphatase-antialkaline phosphatase method. For quantitative analysis a computer-linked analyzing system was used. In contrast to normal skin, keratinocytes of basal and suprabasal layers showed nuclear staining in cholesteatoma epithelium. The extent of nuclear staining of epithelial cells in the cholesteatomas studied was significantly increased. Concurrent cytoplasmic staining was observed in both skin and cholesteatoma, but with a stronger reactivity in the latter. These findings suggest participation of the c-myc oncogene in cholesteatoma epithelium.     

Orbital epidermoids and dermoids

Summary A series of 1 epidermoid and eight dermoid tumors with primary orbital location is reported on. The term cholesteatoma is inadequate to cover epidermoids, dermoids and inflammatory cholesteatomas.The features present in our series and in 81 similar cases collected from literature show that a long standing disaxiale proptosis, without impairment of ocular motility, is indicative of the tumouts under discussion. The X-ray finding of a clearcut patch of bone rarefaction with a marginal hyperostosis is also characteristic of these lesions.Radical surgery is mandatory; a subfrontal extradural approach to orbit is favoured.

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Zusammenfassung Es wird über eine Serie von einem Epidermoid und acht Dermoiden mit primärer Lokalisation in der Orbita berichtet. Der Ausdruck Cholesteatom ist inadäquat, weil er Epidermoide, Dermoide und entzündliche Cholesteatome zusammenfaßt. Die klinischen Bilder der Fälle unserer Serie und von 81 ähnlichen Fällen aus der Literatur zeigen eine disaxiale Proptosis ohne Einschränkung der Augenbeweglichkeit und dies ist für diese Tumorgruppe charakteristisch. Die Röntgenbefunde zeigen eine scharf begrenzte Knochenusur mit Wand-Hyperostose. Radikale Chirurgie ist erforderlich. Eine subfrontale, extradurale Freilegung der Orbita wird von uns bevorzugt.

     

颞骨岩部胆脂瘤

目的：探讨岩部胆脂瘤的临床特征及手术方法。方法：经迷路前上径路手术治疗1例，经迷路-耳蜗径路手术治疗8例。结果：术后8例随访2-9年，局部无胆脂瘤复发，其中2例面神经全程减压，术后未能恢复；1例术后2个月出现面肌运动，7个月后恢复正常，1例术后仅2个月，有待随访。结论：根据病变部位及侵犯范围选择适当的手术途径；术腔内填塞脂肪，封闭外耳道可防止脑脊液外漏。     

继发性三叉神经痛12例临床分析

目的：探讨桥小脑角占位性病变引起的继发性三叉神经痛的临床特征。方法：回顾分析了12例继发性三叉神经痛患者的临床资料，MRI检查7例为桥小脑角胆脂瘤所致，5例为桥小脑角脑膜瘤所致；均经乙状窦后进路显微手术切除肿瘤。结果：肿瘤切除术后无并发症发生；12例三叉神经痛全部治愈。随访3～18个月，无复发。结论:MRI检查是诊断继发性三叉神经痛的主要依据；乙状窦后进路显微手术是治疗继发性三叉神经痛的首选方法.