Wieland Aaron M, Curry William T, Durand Marlene L, Holbrook Eric H
Skull Base. 2010 Nov;20(6):487-90. doi: 10.1055/s-0030-1261264.
Organic foreign bodies of the skull base are an uncommon problem with the potential for serious morbidity that present complicated treatment dilemmas best managed by a multidisciplinary approach. A 58-year-old male presented to the emergency department with fevers and mental status changes and was found to have bacterial meningitis. Computed tomography of the sinuses revealed two adjacent defects of the ethmoid roof with associated soft tissue density concerning for an encephalocele. He had a remote history of a penetrating left maxilla injury with a stick 13 years earlier. An attempted endoscopic repair of the defects revealed a pulsating splinter of wood emanating from the ethmoid roof defect. Neurosurgery and infectious disease were consulted and several wood fragments were removed endoscopically from the intracranial space. The skull base defects were closed using a septal cartilage underlay and free mucosal overlay graft. The patient has done well in follow-up with no evidence of cerebrospinal fluid leak. Organic foreign bodies from skull base trauma can have a delayed presentation and require a multidisciplinary team approach. In the appropriate setting endoscopic removal is a minimally morbid option.
颅底的有机异物是一个不常见的问题，具有导致严重发病的可能性，会带来复杂的治疗难题，最好通过多学科方法进行处理。一名58岁男性因发热和精神状态改变到急诊科就诊，被诊断为细菌性脑膜炎。鼻窦计算机断层扫描显示筛窦顶部有两个相邻缺损，并伴有可疑脑膨出的软组织密度影。他有13年前被木棍穿透左上颌骨的既往史。在内镜下试图修复缺损时，发现从筛窦顶部缺损处有一块搏动的木碎片。咨询了神经外科和传染病科医生后，通过内镜从颅内空间取出了几块木碎片。使用鼻中隔软骨衬垫和游离黏膜覆盖移植物封闭颅底缺损。患者在随访中情况良好，没有脑脊液漏的迹象。颅底创伤导致的有机异物可能会延迟出现，需要多学科团队的方法。在合适的情况下，内镜取出是一种微创的选择。
