Bächinger David, Goosmann Madeline M, Schuknecht Bernhard, Nadol Joseph B, Adams Joe C, Huber Alexander, Eckhard Andreas H
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
University of Zurich, Zurich, Switzerland.
Front Neurol. 2019 Apr 25;10:431. doi: 10.3389/fneur.2019.00431. eCollection 2019.
Posttraumatic Meniere's syndrome is a rare clinical entity. The pathomechanism by which temporal bone trauma leads to fluctuating audiovestibular symptoms, in some cases with a delay of onset many years after trauma, remains elusive. Here, a clinical case and the respective temporal bone imaging data were reviewed to investigate the underlying inner ear pathology. A 44-year-old patient presented with left-sided Meniere's syndrome 34 years after he suffered an ipsilateral temporal bone fracture caused by a car accident. Clinical imaging showed left cochleovestibular hydrops (gadolinium-enhanced MRI) and bony obliteration of the left VA (CT imaging), resulting in discontinuity of the ES. Our findings suggest that a temporal bone fracture with a "retrolabyrinthine" course, traversing the VA, caused intraaqueductal callus bone formation and progressive blockage of the VA. As a result, the extraosseous (distal) endolymphatic sac (eES) became separated from the cochleovestibular labyrinth, an event that presumably underlies endolymphatic hydrops formation and that precipitates the onset of clinical Meniere's symptoms in this case.
创伤后梅尼埃综合征是一种罕见的临床病症。颞骨创伤导致波动性听觉前庭症状的发病机制，在某些情况下创伤后数年才出现症状，目前仍不清楚。在此，回顾了一例临床病例及相应的颞骨影像学资料，以研究潜在的内耳病理学特征。一名44岁患者在因车祸导致同侧颞骨骨折34年后出现左侧梅尼埃综合征。临床影像学显示左侧耳蜗前庭积水（钆增强磁共振成像）以及左侧内淋巴管骨质闭塞（计算机断层扫描成像），导致内淋巴囊中断。我们的研究结果表明，一条“迷路后”走行的颞骨骨折穿过内淋巴管，导致导水管内骨痂形成和内淋巴管逐渐阻塞。结果，骨外（远端）内淋巴囊与耳蜗前庭迷路分离，这一事件可能是内淋巴积水形成的基础，并促使该病例中临床梅尼埃症状的发作。
