Iwaki Sho, Kawakita Daisuke, Matoba Takuma, Minohara Kiyoshi, Iwasaki Shinichi
Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, JPN.
Cureus. 2025 Apr 1;17(4):e81592. doi: 10.7759/cureus.81592. eCollection 2025 Apr.
While osteoradionecrosis of the temporal bone is a late complication of radiotherapy (RT) for external auditory canal carcinoma (EACC), brain abscesses are rare. We present two cases of EACC treated with definitive RT, both of whom subsequently developed brain abscesses. The first patient, a 65-year-old woman with right EACC invading the sigmoid sinus and dura mater, developed a cerebellar abscess eight years post-RT (60 Gy/30 Fr). This abscess, attributed to infection related to temporal bone osteoradionecrosis, was successfully managed with drainage and antibiotics. The second patient, a 45-year-old man with right EACC and suspected dura mater invasion developed a right temporal lobe abscess two months post-RT (70 Gy/35 Fr). Owing to its persistence despite drainage and antibiotics, the abscess was resected, and the skull base was reinforced with a temporalis muscle flap. Neither patient experienced local recurrence. We hypothesize that the brain abscesses resulted from the vulnerability of the dura mater and skull base. Brain abscesses should be considered a potential adverse outcome following definitive RT for EACC, particularly when tumor invasion of the dura mater or skull base is suspected.
虽然颞骨放射性骨坏死是外耳道癌（EACC）放射治疗（RT）的晚期并发症，但脑脓肿较为罕见。我们报告两例接受根治性放疗的EACC患者，两人随后均发生脑脓肿。首例患者为一名65岁女性，患有侵犯乙状窦和硬脑膜的右侧EACC，放疗后8年（60 Gy/30次分割）发生小脑脓肿。该脓肿归因于与颞骨放射性骨坏死相关的感染，通过引流和抗生素治疗成功治愈。第二例患者为一名45岁男性，患有右侧EACC且疑似硬脑膜侵犯，放疗后2个月（70 Gy/35次分割）发生右侧颞叶脓肿。尽管进行了引流和抗生素治疗，脓肿仍持续存在，因此进行了切除，并使用颞肌瓣加固颅底。两名患者均未出现局部复发。我们推测脑脓肿是由硬脑膜和颅底的脆弱性导致的。脑脓肿应被视为EACC根治性放疗后的潜在不良后果，尤其是当怀疑肿瘤侵犯硬脑膜或颅底时。
