耳源性小脑脓肿2例并文献复习

doi:10.6040/j.issn.1673-3770.0.2015.178

摘要/Abstract

摘要： 目的探讨耳源性小脑脓肿的临床特点,提高此类疾病的诊治水平。方法回顾性分析2例耳源性小脑脓肿患者的病历资料,复习相关文献。结果 2例均有慢性耳流脓史,中耳胆脂瘤,入院时表情淡漠,无中枢神经系统体征。患者一在乳突根治后经乳突入路行小脑脓肿穿刺抽脓而治愈;患者二先行乙状窦后入路桥小脑角脑脓肿切除,半个月后再行改良乳突根治而治愈。随访3~6年,均无复发。结论耳源性小脑脓肿并不多见,容易漏诊,处理不当易致死亡,诊断主要依据增强CT及MRI检查。治疗应首选在积极抗感染的基础上,防止颅内压增高,尽早行根治性乳突病灶清除,确保术腔引流通畅,同时尽可能行经乳突入路穿刺抽脓;若患者病情危急,可先行钻颅抽脓,同时行乳突切开引流以提高抗生素的抗菌效果;若多发脓肿者,应先行开颅脓肿切除或与乳突根治同期手术。抗生素敏感、脓肿较小者,有条件的医院可在加强抗感染下先行乳突病灶根治,MRI定期检查随访。彻底清除乳突病灶及选择敏感抗生素是减少耳源性小脑脓肿复发的两个关键因素。

关键词: 耳源性小脑脓肿, 经乳突, 经颅骨入路, 治疗, 慢性化脓性中耳炎

Abstract: Objective To explore the clinical features of otogenic cerebellar abscess in order to improve the diagnosis and treatment of this disease. Methods Clinical data of 2 cases of otogenic cerebellar abscess were retrospectively analyzed and relevant literature was reviewed. Results Both patients were adult, who had symptoms of chronic otorrhea and cholesteatoma in middle ear. On admission, both cases were apathy, having no signs of central nervous system. Case one was cured by aspiration of cerebellar abscess through transmastoid approach after a radical mastoidectomy. Case two was cured by resection of cerebellar abscess in the cerebellopontine angle through trans-retrosigmoid approach first, and then by modified radical mastoidectomy after half a month. During the follow-up of 3-6 years, no recurrence was observed. Conclusion Otogenic cerebellar abscess is rare, which can easily miss diagnosis and lead to death if improperly managed. The diagnosis is based on enhanced CT and MRI scans. For the treatment, based on positive anti-infection, increased intracranial pressure should be prevented, radical debridement on the original lesion in the mastoid should be performed timely to keep drainage smooth, and aspiration of cerebellar abscess in transmastoid cavity should be carried out. If the patient is in critical condition, aspiration by cranial drilling and incision drainage on mastoid must be performed to improve the effect of antibiotics. If the patient suffers from multiple cerebellar abscesses, craniotomy or simultaneous radical mastoidectomy should be conducted. If the antibiotics are sensitive and the abscess is small, the patient may be cured by strengthening anti-infectives, followed by radical resection of mastoid lesions and regular follow-up MRI examinations. Complete removal of the mastoid lesions and selection of sensitive antibiotics are essential to cure otogenous cerebellar abscess.

Key words: Otogenic cerebellar abscess, Therapeutics, Craniotomy, Chronic suppurative otitis media, Transmastoid approach

中图分类号:

R742.8

李兆生, 洪斌, 黄前进, 蒲伟民, 许振跃. 耳源性小脑脓肿2例并文献复习[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 32-37.

LI Zhaosheng, HONG Bin, HUANG Qianjin, PU Weimin, XU Zhenyue. Otogenic cerebellar abscess: report of 2 cases and literature review[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(5): 32-37.

参考文献

[1] Kwak M K, Chung J H, Lee S H, et al. A case of otogenic brain abscess causing loss of consciousness[J]. Korean J Audiol, 2014, 18(2):76-79.
[2] Szyfter W, Kruk-Zagajewska A, Borucki L, et al. Evolution in management of otogenic brain abscess[J]. Otol Neurotol, 2012, 33(3):393-395.
[3] 张秋贵,孙彦,朱富高.耳源性脑脓肿105例临床分析[J].中华耳科学杂志,2003,1(2):36-38. ZHANG Qiugui, SUN Yan, ZHU Fugao. Clinical analysis of 105 cases of otogenic brain abscess[J]. Chin J Otology, 2003, 1(2):36-38.
[4] Cho S H, Park M K, Lee J D, et al. Otogenic brain abscess presenting with gait ataxia[J]. Korean J Audiol, 2012, 16(3):31-34.
[5] Agrawal D, Suri A, Mahapatra A K. Primary excision of pediatric posterior fossa abscesses-towards zero mortality? A series of nine cases and review[J]. Pediatr Neurosurg, 2003, 38(2):63-67.
[6] Pandey P, Umesh S, Bhat D, et al. Cerebellar abscesses in children: excision or aspiration?[J]. J Neurosurg Pediatr, 2008, 1(1):31-34.
[7] Patel K, Clifford D B. Bacterial brain abscess[J]. Neurohospitalist, 2014, 4(4):196-204.
[8] 于新,田增民,李士月,等. 脑脓肿的治疗策略(附45例报告)[J]. 解放军医学杂志,2009,34(1):31-33. YU Xin, TIAN Zengmin, LI Shiyue, et al. Treatment strategy of pyogenic brain abscesses: a report of 45 cases[J]. Med J Chin PLA, 2009, 34(1):31-33.
[9] 李奋强. CT引导下穿刺引流小儿多发性脑脓肿(附10例分析)[J]. 中国微侵袭神经外科杂志,2009,14(2):76-76. LI Fenqiang. Multiple brain abscesses in children are treated by CT-guided puncture and drainage (analysis of 10 cases)[J]. CMINSJ, 2009, 14(2):76.
[10] 樊忠,王天铎.实用耳鼻喉科学[M].济南:山东科学技术出版社,2000: 119-143.
[11] 杜英华,付玉贵,孙化鲲.经乳突腔穿刺抽脓在耳源性脑脓肿治疗中的应用[J].中华耳科学杂志,2007,5(2):152-154. DU Yinghuo, FU Yugui, SUN Huakun. Treatment of otogenic brain abscess by aspiration simultaneously with mastoidectomy[J]. Chin J Otol, 2007, 5(2):152-154.
[12] 杨华,陈晓巍,高志强,等.耳源性颅内并发症临床特点分析[J].中华耳鼻咽喉头颈外科杂志,2008,43(11):801-805. YANG Hua, CHEN Xiaowei, GAO Zhiqiang, et al. Clinical analysis of otogenic intraccanial complications[J]. Chin J Otorhinolaryngol Head Neck Surg, 2008, 43(11):801-805.
[13] 吴净芳,倪道凤,杨见明,等.中耳炎颅内、外并发症的20年临床经验及分析[J].中华耳科学杂志,2008,6(2):170-175. WU Jingfang, NI Daofeng, YANG Jianming, et al. Extracranial and intracranial complications of otitis media: 20 years clinical experience and analysis[J]. Chin J Otology, 2008, 6(2):170-175.
[14] Durisin M, Stöver T, Leinung M, et al. Otogenic cerebellar abscess due to purulent labyrinthitis and defect of the superior semicircular canal and its propagation through the endolymphatic sac[J]. Eur Arch Otorhinolaryngol, 2007, 264(8):955-958.
[15] June Choi, Jong II Choi, Sang-Dae Kim. Management of otogenic brain abscess using the transmastoid approach[J]. J Korean Neurosurg Soc, 2014, 55(3):178-180.
[16] 王莹,孔维佳.中耳炎的颅内外并发症[J].临床耳鼻咽喉科杂志,2003, 17(5): 283-284. WANG Ying, KONG Weijia. Extracranial and intracranial complications of otitis media (with analysis of 60 cases)[J]. J Clin Otorhinolaryngol, 2003, 17(5):283-284.
[17] Viswanatha B, Nsaeeruddin K. Conservative management of otogenic brain abscess with surgical management of attico antral ear disease: a review[J]. Indian J Otolaryngol Head Neck Surg, 2012, 64(2):113-119.
[18] Gadgil N, Patel A J, Gopinath S P. Open craniotomy for brain abscess: a forgotten experience?[J]. Surg Neurol Int, 2013, 4:34.
[19] 刘小梅,张永红,骆宗琼.小儿脑脓肿内外科治疗的疗效对比分析[J].中国实用儿科杂志,2000,15(9):563-564. LIU Xiaomei, ZHANG Yonghong, LUO Zongqiong. Comparison and analysis of the effect of treatment for pediatric cerebral abscess by internal or surgical therapy[J]. Chin J Practical Pedia, 2000, 15(9):563-564.
[20] 沈国民,沈锋,谢壮志,等.胆脂瘤型中耳炎并发小脑脓肿1例[J].中华耳科学杂志,2005,3(4):281. SHEN Guomin, SHEN Feng, XIE Zhuangzhi, et al. One case of cholesteatoma otitis media complicated with cerebellar abscess[J]. Chin J Otology, 2005, 3(4):281.
[21] 梁晓杰,杨仕明,韩东一,等.胆脂瘤型中耳炎颅内外并发症的临床分析[J].中华耳鼻咽喉头颈外科杂志,2005,40(1):10-13. LIANG Xiaojie, YANG Shiming, HAN Dongyi, et al. Clinical analysis of extracranial and intracranial complications of cholesteatoma otitis media[J]. Chin J Otorhinolaryngol Head Neck Surg, 2005, 40(1):10-13.

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