Komatsu Fuminari, Komatsu Mika, Ohmura Tadahiro, Tsugu Hitoshi, Oshiro Shinya, Fukushima Takeo, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Neurol Med Chir (Tokyo). 2010;50(10):949-52. doi: 10.2176/nmc.50.949.
A 37-year-old man involved in a motor vehicle accident was admitted to our hospital with disturbed consciousness. Computed tomography (CT) showed an acute, right-sided epidural hematoma and pneumocephalus. Emergency evacuation of the acute epidural hematoma was carried out, and his condition gradually recovered. However, cerebrospinal fluid (CSF) rhinorrhea continued despite conservative treatment. Three-dimensional reconstructed CT revealed a bone defect, which was approximately 20 mm in size, in the planum sphenoidale and tuberculum sellae, and magnetic resonance imaging demonstrated a traumatic meningo-encephalocele through the defect, with CSF collection in the sphenoid sinus. Endoscopic endonasal transsphenoidal surgery was performed. The 9-mm diameter dural defect was clearly visualized in the sphenoid sinus and was reconstructed with a combination of suturing and overlay with abdominal fascia, and absorbable polyglycolic acid felt. The CSF leakage from a traumatic meningo-encephalocele through the planum sphenoidale was successfully repaired by endoscopic endonasal surgery. Thorough preoperative evaluation of the feasibilities of the endoscopic and transcranial approaches should be based on the preoperative identification of the fistula, the bone defect, and vital structures.
一名37岁男性因机动车事故入院，意识不清。计算机断层扫描（CT）显示急性右侧硬膜外血肿和气颅。对急性硬膜外血肿进行了紧急清除，其病情逐渐恢复。然而，尽管进行了保守治疗，脑脊液鼻漏仍持续存在。三维重建CT显示蝶骨平台和鞍结节有一个大小约为20毫米的骨缺损，磁共振成像显示通过该缺损有外伤性脑膜脑膨出，蝶窦内有脑脊液积聚。遂行鼻内镜经蝶窦手术。在蝶窦中清晰可见直径9毫米的硬脑膜缺损，采用缝合和腹筋膜覆盖及可吸收聚乙醇酸毡片相结合的方法进行修复。通过鼻内镜经鼻手术成功修复了经蝶骨平台外伤性脑膜脑膨出导致的脑脊液漏。术前应根据瘘口、骨缺损和重要结构的术前识别，全面评估内镜和经颅入路的可行性。
