耳源性颅内并发症20例临床诊疗分析

Diagnosis and Treatment of Otogenic Intracranial Complications in 20 Cases

目的分析耳源性颅内并发症的临床表现,探讨其诊断及治疗方式。方法对2013年6月~2019年6月期间治疗的20例耳源性颅内并发症患者的临床表现、检查方法、治疗方式等进行回顾性分析。结果耳源性颅内并发症中脑脓肿占70%;临床表现主要为典型的头痛、发热及神经系统症状;术后病理证实90%为胆脂瘤型中耳炎,颅脑MR检查显示脑脓肿患者脑实质长T1、T2信号,磁共振静脉成像(MRV)检查显示乙状窦区不显影;90%的患者行乳突根治术后治愈并无复发。结论耳源性颅内并发症以脑脓肿最为多见,结合典型的临床表现及颅脑MR、MRV检查可及时进行诊断,中耳胆脂瘤是造成颅内并发症的重要因素,及时的乳突手术对于缓解症状改善预后防止复发具有重要作用。

Objective To report etiologies and clinical characteristics of otogenic intracranial complications,as well as its diagnosis and treatment,in 20 cases.Methods Data from 20 cases of otogenic intracranial complications treated between June 2013 and June 2019 were retrospectively reviewed,including clinical manifestations,examination methods and treatments.Results The rate of brain abscess was 70%,presenting mainly with headaches,fever and nervous system symptoms,with cholesteatoma otitis media confirmed in most of these cases(90%)and MR imaging showings long T1 and T2 signature signals in brain parenchyma and MRV suggesting sigmoid sinus blockage.Full recovery without recurrence was achieved after mastoidectomy in 90%of these patients.Conclusion Brain abscess is the most common form of otogenic intracranial complications.Timely diagnosis is possible based on typical clinical manifestations and brain MR and MRV data.Middle ear cholesteatoma is an important disease causing intracranial complications.Timely mastoidectomy plays an important role in resolving symptoms,improving prognosis and preventing recurrence.