内镜下手术治疗儿童先天性颅底型脑膜脑膨出的临床分析

Endoscopic surgery for congenital basal meningoencephaloceles in children

目的探讨经内镜手术方式治疗儿童先天性颅底型脑膜脑膨出并进行颅底重建的有效性及安全性。方法回顾性分析2011年1月~2014年10月收治的6例儿童先天性颅底型脑膜脑膨出患儿病例资料,其中鼻内型4例,蝶咽型2例。术中颅底缺损重建材料分别为中鼻甲骨及黏膜瓣2例,鼻中隔软骨及带蒂鼻中隔黏膜瓣2例,肋软骨-人工硬脑膜-疝囊黏膜瓣1例,筛骨垂直板-人工硬脑膜-带蒂鼻中隔黏膜瓣1例。结果 6例患儿均一次性经内镜行脑膜脑膨出切除术并成功进行颅底重建。术后随访6个月以上,无复发、鼻中隔穿孔、视力障碍、内分泌紊乱、脑脊液鼻漏及脑膜炎等并发症。结论经内镜进行儿童先天性颅底型脑膜脑膨出切除＋颅底缺损重建术是一种安全、有效的手术方式,具有操作简便、创伤小、并发症少等优点。

Objective To explore the safety and effectiveness of endoscopic surgery for congenital basal meningoencephalocele in children. Methods Clinical data of 6 children with congenital basal meningoencephaloceles undergoing endoscopic surgery in our hospital between Jan. 2011 to Oct. 2014 were analyzed retrospectively. Of them,4suffered from meningoencephalocele of transethmoidal subtype and 2 of transsphenoidal subtype. The repair materials for skull base reconstruction included middle turbinate and mucosal flap（ 2 cases）,nasoseptal cartilage and vascularized nasoseptal mucosal flap（ 2 cases）, costicartilage-artificial duramater-mucosal flap of hernial sac（ 1 case）, and perpendicular plate of ethmoid bone-artificial duramater-vascularized nasoseptal mucosal flap（ 1 case）. Results Endoscopic resection of meningoencephalocele and repair of fistula in skull base at once succeeded in all 6 cases. All children were followed up for more than 6 months postoperatively without any complications such as recurrence,nasal septum perforation,visual impairment,endocrine disorder,cerebrospinal fluid rhinorrhea or meningitis. Conclusion With advantages of excellent visualization,easy procedure,less injury and complications,endoscopic technique is a safe and effective method for congenital basal meningoencephalocele in children.