Falcioni M, Aristegui M, Landolfi M, Saleh E, Taibah A K, Russo A, Sanna M
Servizio O.R.L, Hospital Central Cruz Roja, Madrid, Spagna.
Acta Otorhinolaryngol Ital. 1995 Aug;15(4):305-11.
Herniation of meningeal and/or encephalic tissue into the middle ear is a pathology which, even if rarely found by the otologist, can be life-threatening for the patient because of eventual infective intracranial complications. Four different etiological types are possible, infective, post-surgical, traumatic and spontaneous. From a pathogenic point of view, all types are characterized by a bony and dural defect localized in the tegmen through which meningeal and encephalic tissue can herniate. Symptomatology is often non-specific so that some cases are diagnosed during surgery. When there is strong suspicion of herniation neuroradiological assessment procedures must be carried out in order to make a correct pre-operative diagnosis, High Resolution Computed Tomography (HRCT) of the temporal bone in particular, can show the exact limits and location of the bone defect, while Magnetic Resonance Imaging (MRI) allows the nature of the tissue in the middle ear to be determined. Surgery is the only appropriate therapy. Different approaches have been described amongst which the transmastoid with or without temporal minicraniotomy and the middle cranial fossa (MCF) are the most frequently reported literature. From June 1982 to March 1994, 27 consecutive cases underwent surgery at the Gruppo Otologico, Piacenza. As a result of the occurrence of postoperative meningitis in one case, a new surgical technique through the MCF was standardized. The main step of this procedure consist in leaving the herniated tissue in situ so as to make a barrier between the middle ear and subdural space. The technique is indicated either in the case of large, multiple or very anteriorly located bony defects or when there is an infection in the middle ear.
脑膜和/或脑组织疝入中耳是一种病理情况，即使耳科医生很少发现，但由于可能出现颅内感染并发症，对患者来说可能危及生命。可能有四种不同的病因类型，即感染性、手术后、创伤性和自发性。从发病机制来看，所有类型的特征都是在鼓室盖存在骨质和硬脑膜缺损，脑膜和脑组织可通过此缺损疝出。症状通常不具特异性，以至于有些病例是在手术中才被诊断出来。当高度怀疑有疝出时，必须进行神经放射学评估程序以做出正确的术前诊断。特别是颞骨的高分辨率计算机断层扫描（HRCT）可以显示骨缺损的确切范围和位置，而磁共振成像（MRI）则可以确定中耳内组织的性质。手术是唯一合适的治疗方法。已经描述了不同的手术入路，其中经乳突入路（有或无颞部微型开颅术）和中颅窝（MCF）入路是文献中报道最频繁的。1982年6月至1994年3月，皮亚琴察的Gruppo Otologico连续有27例患者接受了手术。由于其中1例发生了术后脑膜炎，一种通过中颅窝的新手术技术得以标准化。该手术的主要步骤是将疝出的组织留在原位，以便在中耳和硬膜下腔之间形成一道屏障。该技术适用于存在大的、多发的或非常靠前的骨缺损的情况，或者中耳有感染时。
