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題 名 | 立即內視鏡手術修補腦脊髓液鼻漏併發腦膿瘍--病例報告=Immediate Endoscopic Repair of Cerebrospinal Fluid Leakage Complicated by a Brain Abscess--A Case Report |
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作 者 | 邱建皓; 李應璋; 許家禎; | 書刊名 | 慈濟醫學 |
卷 期 | 16:2 2004.04[民93.04] |
頁 次 | 頁131-136 |
分類號 | 416.854 |
關鍵詞 | 鼻竇內視鏡手術; 腦脊髓液鼻漏; 腦膿瘍; Cerebrospinal fluid rhinorrhea; Endoscopic sinus surgery; Brain abscess; |
語 文 | 中文(Chinese) |
中文摘要 | 腦膿瘍是鼻竇內視鏡手術時少見的嚴重併發症,其臨床症狀多變而不容易早期發現。一名58歲男性因為再次復發性慢性鼻竇炎接受鼻竇內視鏡手術。術後3週,於潛水後陸續出現頭痛、發燒、嘔吐等症狀。在疑似腦膜炎下住院,腦脊髓液及腦部電腦斷層檢查皆正常。局部檢查發現左側篩竇頂有肉芽組織及膿液,在局部麻醉下以內視鏡施行清創手術。不幸在移除肉芽組織後,出現腦脊髓液滋漏的現象。當時立即以對側的中鼻甲黏膜骨瓣修補。手術後1週,病患再度出現頭痛及噁心等症狀。追蹤腦部電腦斷層,發現左前額葉有顱內血腫。經保守治療2週後,血腫及臨床症狀逐漸緩解,在沒有任何神經學併發症下出院。出院後2日,病患又出現前額劇烈頭痛、噁心、嘔吐等症狀而再度入院。再經數次腦脊髓液檢查皆正常,也無腦膜炎之相關症狀。但是1週後,腦部電腦斷層卻出現同一位置的腦膿瘍。經積極抗生素治療3週後痊癒,無神經學之併發症。此病例顯示:使用立即內視鏡手術修補腦脊髓液鼻漏,可能併發腦膿瘍。若僅靠腦脊髓液或神經學檢查之正常報告,並不能排除腦膿瘍的可能性。如果病患的臨床症狀仍然持續或進一步惡化時,要追蹤影像檢查以確定診斷。因此高度警覺、早期診斷、儘早治療是最重要的方針。 |
英文摘要 | Major complications of functional endoscopic sinus surgery (FESS), such as brain abscesses, are uncommon. Clinical symptoms and signs of brain abscesses are variable and difficult to identify in the early diagnosis. A 58-year-old man who had undergone revised endoscopic sinus surgery suffered from headaches, fever, and vomiting after going diving 3 weeks after surgery. He was admitted for wound infection and to rule out central nerve system infection. Results of lumbar puncture and computed tomography (CT) were unremarkable. The patient underwent endoscopic debridement, and a defect about 1×0.5 cm in size with cerebrospinal fluid (CSF) leakage was noted after removal of granulationtissue from the left ethmoid roof. Endoscopic repair of the defect was immediately performed transnasally using free osteo-mucoperiosteal grafts from the other side of the middle turbinate. One week later, the patient developed recurrent headaches. CT scan identified a 2×0.5 cm left frontal lobe hematoma with focal edema and with normal CSF. After conservative treatment with antibiotics for 2 weeks, the hematoma resolved and the clinical symptoms and signs of the patient had improved. Two days after discharge, the patient was readmitted for severe frontal headache, nausea, and vomiting. Several repeated lumbar punctures revealed normal CSF. A follow-up CT showed a 2~3 mL abscess in the left frontal lobe with significant ring enhancement. Antibiotics for a further 3 weeks allowed the patient to be discharged with no further neurologic sequelae. The case demonstrates that CSF leakage after repair may be complicated by infection, and that brain abscess cannot be rule out even with normal lumbar puncture and neurologic findings. If a patient’s clinical symptoms and signs change or worsen, follow-up imaging is indicated. A high index of suspicion and early diagnosis followed by adequate treatment are crucial. |
本系統中英文摘要資訊取自各篇刊載內容。