Antonelli Vincenzo, Cremonini Anna Maria, Campobassi Angelo, Pascarella Rosario, Zofrea Giovanni, Servadei Franco
Division of Neurosurgery Ospedale Maurizio Bufalini, Cesena, Italy.
Surg Neurol. 2002 Feb;57(2):117-25. doi: 10.1016/s0090-3019(01)00667-x.
Orbital roof fractures after blunt injury are rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 15 cases published to date.
The clinical, radiological, and surgical findings of 6 cases of traumatic encephalocele treated at our institution from June 1998 to January 2000 are presented. They are also compared with previously published series.
In contrast to other published cases, 5 out of 6 patients in our series were adults. The most common cause of trauma was road traffic accident. Ecchymosis and preoperative exophthalmos/proptosis were frequent. In all of our patients a coronal CT scan (3 mm increments with bone windows) was obtained. It demonstrated the extension of the orbital roof fractures and a possible encephalocele in 4 cases. Associated frontal brain contusions were seen in 5 cases. An MRI was performed in 3 patients (and only in 2 previously published cases); it showed the extension of the brain herniation into the orbital cavity. Surgical treatment via a fronto-basal approach with evacuation of the contused herniated brain tissue and orbital roof reconstruction was performed. The outcome at 6 months was good recovery in five patients with one patient still in a persistent vegetative state. Postoperatively the ocular disturbances improved in 5 cases. A review of the other published cases confirmed recovery of normal ocular function in the vast majority of the cases.
Whenever orbital roof fractures associated with frontal contusions are identified in an acute brain injured patient, an orbital encephalocele should be suspected. In our opinion MRI is the investigation of choice in such patients. If the encephalocele is confirmed, a surgical approach via the subfrontal route is indicated with resection of herniated contused brain tissue, dural closure, and orbital roof reconstruction. Good results in regard to the orbital symptoms (mainly exophthalmos) can be expected.
钝器伤后眶顶骨折较为罕见。眶腔内的创伤性脑膨出更为罕见，迄今为止仅有15例报道。
本文介绍了1998年6月至2000年1月在我院接受治疗的6例创伤性脑膨出患者的临床、影像学及手术结果。并与既往发表的病例系列进行了比较。
与其他已发表病例不同，我们系列中的6例患者中有5例为成年人。最常见的创伤原因是道路交通事故。瘀斑和术前眼球突出较为常见。我们所有患者均进行了冠状位CT扫描（骨窗，层厚3mm）。4例显示眶顶骨折的范围及可能存在的脑膨出。5例伴有额叶脑挫伤。3例患者进行了MRI检查（既往发表的病例中仅有2例）；显示脑疝延伸至眶腔。采用额底部入路手术，清除挫伤的疝出脑组织并重建眶顶。6个月时，5例患者恢复良好，1例仍处于持续性植物状态。术后5例患者的眼部障碍有所改善。对其他已发表病例的回顾证实，绝大多数病例的眼功能恢复正常。
对于急性脑损伤患者，一旦发现眶顶骨折伴有额叶挫伤，应怀疑存在眶内脑膨出。我们认为MRI是此类患者的首选检查方法。若确诊为脑膨出，应采用额下途径手术，切除疝出的挫伤脑组织、封闭硬脑膜并重建眶顶。有望在眼眶症状（主要是眼球突出）方面取得良好效果。
