耳源性小脑脓肿2例并文献复习

Otogenic cerebellar abscess: report of 2 cases and literature review

目的：探讨耳源性小脑脓肿的临床特点，提高此类疾病的诊治水平。方法回顾性分析2例耳源性小脑脓肿患者的病历资料，复习相关文献。结果2例均有慢性耳流脓史，中耳胆脂瘤，入院时表情淡漠，无中枢神经系统体征。患者一在乳突根治后经乳突入路行小脑脓肿穿刺抽脓而治愈；患者二先行乙状窦后入路桥小脑角脑脓肿切除，半个月后再行改良乳突根治而治愈。随访3～6年，均无复发。结论耳源性小脑脓肿并不多见，容易漏诊，处理不当易致死亡，诊断主要依据增强CT及MRI检查。治疗应首选在积极抗感染的基础上，防止颅内压增高，尽早行根治性乳突病灶清除，确保术腔引流通畅，同时尽可能行经乳突入路穿刺抽脓；若患者病情危急，可先行钻颅抽脓，同时行乳突切开引流以提高抗生素的抗菌效果；若多发脓肿者，应先行开颅脓肿切除或与乳突根治同期手术。抗生素敏感、脓肿较小者，有条件的医院可在加强抗感染下先行乳突病灶根治，MRI定期检查随访。彻底清除乳突病灶及选择敏感抗生素是减少耳源性小脑脓肿复发的两个关键因素。

Objective To explore the clinical features of otogenic cerebellar abscess in order to improve the diagnosis and treatment of this disease.Methods Clinical data of 2 cases of otogenic cerebellar abscess were retrospectively ana-lyzed and relevant literature was reviewed.Results Both patients were adult,who had symptoms of chronic otorrhea and cholesteatoma in middle ear.On admission,both cases were apathy,having no signs of central nervous system. Case one was cured by aspiration of cerebellar abscess through transmastoid approach after a radical mastoidectomy. Case two was cured by resection of cerebellar abscess in the cerebellopontine angle through trans-retrosigmoid approach first,and then by modified radical mastoidectomy after half a month.During the follow-up of 3-6 years,no recurrence was observed.Conclusion Otogenic cerebellar abscess is rare,which can easily miss diagnosis and lead to death if improperly managed.The diagnosis is based on enhanced CT and MRI scans.For the treatment,based on positive anti-infection,increased intracranial pressure should be prevented,radical debridement on the original lesion in the mastoid should be performed timely to keep drainage smooth,and aspiration of cerebellar abscess in transmastoid cavity should be carried out.If the patient is in critical condition,aspiration by cranial drilling and incision drainage on mastoid must be performed to improve the effect of antibiotics.If the patient suffers from multiple cerebellar abscesses,craniotomy or simultaneous radical mastoidectomy should be conducted.If the antibiotics are sensitive and the abscess is small,the patient may be cured by strengthening anti-infectives,followed by radical resection of mastoid lesions and regular follow-up MRI examinations.Complete removal of the mastoid lesions and selection of sensitive antibiotics are essential to cure otogenous cerebellar abscess.