Chen M, Gao J, Liu W, Han Z L, Yang Y, Shao J B, Zheng J, Zhang J
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing Key Laboratory for Pediatric Diseases of otolaryngology Head and Neck Surgery, Beijing 100045, China.
Department of Radiology, Beijing Children' s Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 May 7;58(5):452-459. doi: 10.3760/cma.j.cn115330-20220527-00310.
To explore the imaging evaluation of cerebrospinal fluid (CSF) otorrhea associated with inner ear malformation (IEM) in children. The clinical data of 28 children with CSF otorrhea associated with IEM confirmed by surgical exploration in Beijing Children's Hospital, from Nov, 2016 to Jan, 2021, were analyzed retrospectively,including 16 boys and 12 girls, aged from 8-month to 15-year and 8-month old, with a median age of 4-year old. The shapes of stapes were observed during the exploration surgery, and the imaging features of temporal bone high resolution CT(HRCT) and inner ear MRI pre- and post-operation were analyzed. In 28 children with CSF otorrhea, 89.3%(25/28) had stapes footplates defect during exploration. Preoperative CT showed indirect signs such as IEM, tympanic membrane bulging, soft tissue in the tympanum and mastoid cavity. IEM included four kinds: incomplete partition type I (IP-Ⅰ), common cavity (CC), incomplete partition type Ⅱ (IP-Ⅱ), and cochlear aplasia (CA); 100%(28/28) presented with vestibule dilation; 85.7%(24/28) with a defect in the lamina cribrosa of the internal auditory canal. The direct diagnostic sign of CSF otorrrhea could be seen in 73.9%(17/23) pre-operative MRI: two T2-weighted hyperintense signals between vestibule and middle ear cavity were connected by slightly lower or mixed intense T2-weighted signals, and obvious in the coronal-plane; 100%(23/23) hyperintense T2-weighted signals in the tympanum connected with those in the Eustachian tube.In post-operative CT, the soft tissues in the tympanum and mastoid cavity decreased or disappeared as early as one week. In post-operative MRI, the hyperintense T2-weighted signals of tympanum and mastoid decreased or disappeared in 3 days to 1 month,soft tissues tamponade with moderate intense T2-weighted signal were seen in the vestibule in 1-4 months. IP-Ⅰ, CC, IP-Ⅱ and CA with dilated vestibule can lead to CSF otorrhea. Combined with special medical history, T2-weighted signal of inner ear MRI can provide diagnostic basie for most children with IEM and CSF otorrhea.HRCT and MRI of inner ear can also be used to evaluate the effect of surgery.
探讨儿童内耳畸形（IEM）合并脑脊液耳漏的影像学评估。回顾性分析2016年11月至2021年1月在北京儿童医院经手术探查确诊的28例IEM合并脑脊液耳漏患儿的临床资料，其中男16例，女12例，年龄8个月至15岁8个月，中位年龄4岁。手术探查时观察镫骨形态，分析颞骨高分辨率CT（HRCT）及内耳MRI术前、术后的影像学特征。28例脑脊液耳漏患儿中，89.3%（25/28）探查时存在镫骨足板缺损。术前CT表现为IEM、鼓膜膨隆、鼓室及乳突腔内软组织等间接征象。IEM包括四种类型：不完全分隔I型（IP-Ⅰ）、共同腔（CC）、不完全分隔Ⅱ型（IP-Ⅱ）和耳蜗发育不全（CA）；100%（28/28）表现为前庭扩大；85.7%（24/28）存在内耳道筛板缺损。术前MRI中73.9%（17/23）可见脑脊液耳漏的直接诊断征象：前庭与中耳腔之间两个T2加权高信号通过略低或混合强度的T2加权信号相连，在冠状面显示明显；100%（23/23）鼓室内T2加权高信号与咽鼓管内高信号相连。术后CT显示鼓室及乳突腔内软组织最早在术后1周减少或消失。术后MRI显示鼓室及乳突的T2加权高信号在3天至1个月内降低或消失，1至4个月时前庭内可见中等强度T2加权信号的软组织填塞。伴有前庭扩大的IP-Ⅰ、CC、IP-Ⅱ和CA可导致脑脊液耳漏。结合特殊病史，内耳MRI的T2加权信号可为大多数IEM合并脑脊液耳漏患儿提供诊断依据。内耳HRCT和MRI还可用于评估手术效果。
