耳源性小脑脓肿2例并文献复习

doi:10.6040/j.issn.1673-3770.0.2015.178

Abstract

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

CLC Number:

R742.8

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.

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Otogenic cerebellar abscess: report of 2 cases and literature review

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