Kraus E M, McCabe B F
Ann Otol Rhinol Laryngol. 1982 May-Jun;91(3 Pt 1):237-9. doi: 10.1177/000348948209100301.
A new entity, the giant apical air cell syndrome, is presented and its surgical management is described. The syndrome triad consists of a giant apical air cell, spontaneous CSF rhinorrhea, and recurrent meningitis. Constant pounding of the brain against the dura overlying the giant air cell eventually, cause dural rupture and CSF leak. The giant apical air cell communicates with the eustachian tube creating a direct route for CSF to leak from the subarachnoid space into the nasopharynx. The syndrome is best diagnosed by polytomography of the petrous apex, surgical exploration, and careful dissection using the operating microscope. Dye or contrast studies are no longer necessary. Extracranial surgical management is preferable to the intracranial approach. Tympanomastoidectomy is performed with obliteration of the eustachian tube, middle ear, and mastoid. In this manner, the subarachnoid space is separated from the nasopharynx, preventing further episodes of meningitis. A detailed knowledge of the regional anatomy and the application of basic surgical principles should enable the temporal bone surgeon to accurately diagnose and manage most CSF fistulae.
本文介绍了一种新的病症——巨大顶端气房综合征，并描述了其手术治疗方法。该综合征三联征包括巨大顶端气房、自发性脑脊液鼻漏和复发性脑膜炎。大脑不断撞击覆盖巨大气房的硬脑膜最终会导致硬脑膜破裂和脑脊液漏。巨大顶端气房与咽鼓管相通，为脑脊液从蛛网膜下腔漏入鼻咽部创造了一条直接通道。该综合征最好通过岩尖多层断层扫描、手术探查以及使用手术显微镜进行仔细解剖来诊断。不再需要进行染料或造影剂研究。颅外手术治疗优于颅内入路。进行鼓室乳突切除术，同时封闭咽鼓管、中耳和乳突。通过这种方式，蛛网膜下腔与鼻咽部隔开，防止脑膜炎再次发作。对局部解剖结构的详细了解和基本手术原则的应用应能使颞骨外科医生准确诊断和处理大多数脑脊液瘘。
