Suyama K, Horimoto C, Tsutsumi K, Yasunaga A, Asou H, Okamoto K
Department of Neurosurgery, Yahata Hospital, Kitakyushu, Japan.
No Shinkei Geka. 1989 May;17(5):473-6.
A 16 year-old female was admitted to our hospital because of left temporal bone fracture and brain contusion in the left temporal lobe. CSF otorrhea was also present for a week. Four years later, when she was 20 years old, she was noticed to have a white mass in the left external auditory canal. One and a half year later, left CSF otorrhea reappeared, and she was readmitted to our hospital. High resolution coronal CT revealed that the left temporal bone fracture had opened widely and brain tissue had herniated into the left external auditory canal. Metrizamide CT cisternography showed that CSF was leaking around the mass. Operative findings have shown that there were two dural defects, both of which were 2 cm in diameter, and brain tissue surrounded by arachnoid membrane had herniated through these defect. The herniated brain tissue was removed, and both dural- and osteo-plasty were successfully carried out. This case indicates that dissociation of temporal bone fracture and laceration of dura mater may cause herniation of brain tissue and CSF otorrhea years later.
一名16岁女性因左侧颞骨骨折及左侧颞叶脑挫伤入院。脑脊液耳漏也已持续一周。四年后,她20岁时,被发现左侧外耳道有一白色肿物。一年半后,左侧脑脊液耳漏再次出现,她再次入院。高分辨率冠状位CT显示左侧颞骨骨折广泛裂开,脑组织疝入左侧外耳道。甲泛葡胺CT脑池造影显示肿物周围有脑脊液漏。手术所见有两处硬脑膜缺损,直径均为2厘米,蛛网膜包裹的脑组织通过这些缺损疝出。切除疝出的脑组织,并成功进行了硬脑膜和骨成形术。该病例表明,颞骨骨折分离和硬脑膜撕裂可能在数年之后导致脑组织疝出和脑脊液耳漏。