Neely J G, Kuhn J R
Laryngoscope. 1985 Nov;95(11):1299-300. doi: 10.1288/00005537-198511000-00001.
Iatrogenic brain herniation, with meninges (meningoencephalocele) or without meninges (encephalocele), following mastoidectomy is rare. However, the seriousness of the complication and the potential for its prevention necessitate periodic review and emphasis. In this study, 6 patients with small iatrogenic dural injury during mastoidectomy, 1 patient with postoperative large encephalocele, and 2 patients with three spontaneous meningoencephaloceles are reviewed. These cases, and the literature, support the following: 1. A dural injury is necessary for herniation. 2. If the arachnoid remains intact, a meningoencephalocele results with the potential for cerebrospinal fluid leak into the middle ear and recurrent meningitis. 3. If the arachnoid is not intact, an encephalocele results which presents predominantly as a mass without a cerebrospinal fluid leak. 4. The dura and arachnoid may be torn during mastoidectomy, resulting in an immediate cerebrospinal fluid leak that can go easily unrecognized. Taking time to carefully inspect any area of dural exposure obviates this oversight. 5. A satisfactory technique of tegmen and dural-arachnoid repair in these ten cases is described.
乳突切除术后发生的医源性脑疝，伴脑膜（脑膜脑膨出）或不伴脑膜（脑膨出）的情况较为罕见。然而，鉴于该并发症的严重性及其预防的可能性，有必要定期进行回顾并加以强调。在本研究中，对6例乳突切除术中发生小的医源性硬脑膜损伤的患者、1例术后发生巨大脑膨出的患者以及2例自发性脑膜脑膨出患者进行了回顾。这些病例以及相关文献支持以下观点：1. 硬脑膜损伤是脑疝形成的必要条件。2. 如果蛛网膜保持完整，则会形成脑膜脑膨出，有脑脊液漏入中耳及复发性脑膜炎的可能。3. 如果蛛网膜不完整，则会形成脑膨出，主要表现为肿块且无脑脊液漏。4. 硬脑膜和蛛网膜可能在乳突切除术中被撕裂，导致立即出现脑脊液漏，且很容易未被识别。花时间仔细检查硬脑膜暴露的任何区域可避免这种疏忽。5. 描述了这10例患者中颞骨鼓室盖及硬脑膜 - 蛛网膜修复的满意技术。
