Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy.
Acta Otorhinolaryngol Ital. 2013 Apr;33(2):97-101.
Meningoencephalic herniation (MEH) in the middle ear and mastoid is a rare pathological entity with possible life-threatening complications. We treated 24 patients with a trans-mastoid approach, and the bony defect was closed by heterologous materials positioned in a multilayer fashion. The cause of the bony defect were chronic otitis media with cholesteatoma, iatrogenic, spontaneous and post-traumatic. The major presenting symptoms were meningitis, headache, conductive hearing loss, cerebrospinal fluid (CSF leak), neurologic deficit and pneumoencephalus, and stenosis of a canal wall down cavity. During follow-up, no patient developed complications due to surgery or related to the pathology, and imaging showed a stable occlusion of the bony defect. Different surgical treatments have been proposed to repair MEH, and the choice is based on the localization and size of the bony defect, preoperative auditory function and the presence of a coexisting pathology. We propose the use of collagenous membranes and bone substitutes for reconstruction of the floor of the middle fossa.
中耳和乳突脑膜脑膨出（MEH）是一种罕见的病理实体，可能导致危及生命的并发症。我们采用经乳突入路治疗了 24 例患者，通过多层定位的异种材料封闭骨缺损。骨缺损的病因包括慢性中耳炎伴胆脂瘤、医源性、自发性和外伤性。主要表现症状为脑膜炎、头痛、传导性听力损失、脑脊液（CSF）漏、神经功能缺损和脑积气、以及管腔壁下腔狭窄。在随访期间，没有患者因手术或与病理学相关的原因而出现并发症，影像学显示骨缺损稳定闭塞。已经提出了不同的手术治疗方法来修复 MEH，选择取决于骨缺损的定位和大小、术前听觉功能以及是否存在并存病理。我们建议使用胶原膜和骨替代物重建中颅窝底。
