经鼻内镜治疗鼻内型脑膜脑膨出（附4例病例）

目的探讨鼻内型脑膜脑膨出的诊断和鼻内镜微创外科治疗的方法。方法4例表现为鼻腔和鼻咽部肿块患者。例1．女性，11个月，患儿出生后反复右鼻流水样分泌物，经常高烧，且持续时间长，CT检查见右侧筛顶部有颅骨缺损，脑膜突入鼻腔。例2，男性，5岁，行CT及MRI检查，发现鼻腔有新生物，诊断为“鼻腔脑膜脑膨出”。例3，男性，49d，出生后发现患儿右鼻塞，鼻窦CT检查右侧筛顶部有颅骨缺损，诊断为“右鼻腔脑膜脑膨出（鼻内型）”。例4，男性，65岁，右鼻腔阻塞1年在当地医院就诊．拟诊为“鼻息肉”行鼻内镜手术，术中发现鼻腔新生物来源于筛顶，暂停手术，行鼻窦CT检查见右侧筛顶部有颅骨缺损，诊断为“右鼻腔脑膜脑膨出（鼻内型）”。4例患者病理脑组织检查符合脑膜脑膨出诊断。总结先天性鼻内型脑膜脑膨出的临床表现、影像学资料及外科治疗方法。结果患侧水样鼻漏、鼻塞、鼻腔肿块是鼻内型脑膜脑膨出的重要临床表现．尤其是有反复高热和脑膜炎表现的患儿，必须做影像学检查明确诊断。对鼻内型脑膜脑膨出．无论缺损部位在筛顶或颅底均可采用鼻内镜修补手术。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、微创、并发症少等优点。

Transnasal endoscopic treatment in intranasal meningoencephaloceles

Objective To discuss the diagnosis and endoscopic surgical treatment of meningoencephaloceles in nasal cavity. Methods The data of 4 cases of congenital mengingoencephaloceles which have manifested of mass in nasal cavity or nasopharynx were analyzed with the following paramenters eg. clinical features, radiographic imaging and surgical procedures. Results The clinical manifestations of endonasal meningoencephaloceles were watery rhinorrhea,nasal obstruction and mass in nasal cavity. Especially in those patients with reiterative high fever or meningitis,the imaging examination should be done for confirming the diagnosis. No matter where the bone defects were located,ethmoid roof or skull base,endonasal meningoencephaloceles could be removed by endoscopic surgery. Conclusion The CT and MRI are significant in diagnosis of endonasal meningoencephaloceles,nasal endoscopic surgery could be considered as a safe,simple and mini-injury surgical procedure with less complications.