Puyraud S, Sauvage J P, Aubry K
CHRU Dupuytren, Service ORL, F-87042 Limoges, France.
Rev Laryngol Otol Rhinol (Bord). 2003;124(4):247-53.
Less than 150 cases of cerebro-spinal fluid leak with spontaneous defect of the roof of the temporal bone have been described in the international literature.
Is to define this pathology, to describe the clinical features, to suggest a diagnostic strategy, and to clarify the treatment method and the hypotheses on causation.
This is a retrospective study of 3 cases.
At the first medical examination, the most common clinical feature is serous otitis media or otorrhea after myringotomy. Rhinorrhea is rarely pointed out by the patients but exists in our 3 observations. The diagnosis of cerebro-spinal fluid leak with spontaneous defect of the roof of the temporal bone needs; cerebro-spinal fluid leakage, absence of an otologic history or cranial trauma and a bony defect on CT scan. CT scan with millimeter slices is able to show the location and the size of the bony defect(s) of the roof of the temporal bone and often shows partial or total opacity of the middle ear cavities. MRI is able to show if this opacity exists in conjunction with meningeal hernia or cerebro-meningeal hernia. Surgical repair consists of placing an autologous graft over the bony defect by the middle fossa approach. The origin of a spontaneous defect of the temporal bone is discussed. We study the hypothesis in which arachnoïd granulations could be responsible for a temporal bone defect.
国际文献中描述的颞骨顶自发性缺损伴脑脊液漏的病例少于150例。
是定义这种病理状况，描述其临床特征，提出诊断策略，并阐明治疗方法及病因假说。
这是一项对3例病例的回顾性研究。
在首次医学检查时，最常见的临床特征是浆液性中耳炎或鼓膜切开术后耳漏。患者很少指出有鼻漏，但在我们的3例观察中均存在。颞骨顶自发性缺损伴脑脊液漏的诊断需要；脑脊液漏、无耳部病史或颅脑外伤以及CT扫描显示有骨缺损。毫米层厚的CT扫描能够显示颞骨顶骨缺损的位置和大小，且常显示中耳腔部分或完全浑浊。MRI能够显示这种浑浊是否与脑膜疝或脑 - 脑膜疝同时存在。手术修复包括通过中颅窝入路在骨缺损处放置自体移植物。讨论了颞骨自发性缺损的起源。我们研究了蛛网膜颗粒可能导致颞骨缺损的假说。
