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題名 | Meningoencephalocele of the Temporal Bone Repaired with a Free Temporalis Muscle Flap--Case Report=以游離顳骨肌瓣修補顳骨腦膜膨出--病例報告 |
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作者 | 陳甘斌; 陳培榕; 周昱甫; | 書刊名 | 慈濟醫學 |
卷期 | 18:2 民95.04 |
頁次 | 頁149-153+166 |
分類號 | 416.82 |
關鍵詞 | 腦膜腦膨出; 乳突鑿開術; 游離顳肌皮瓣; 多層次修補; Meningoencephalocele; Transmastoid approach; Free temporalis muscle; Multilayered closure; |
語文 | 英文(English) |
中文摘要 | 顱底破裂後造成腦膜腦膨出並突出至外耳道,形成外耳道腫瘤,臨床上相當罕見。常須切除腫瘤並用瓣膜修補缺損。本院經歷一位26歲女性病患,主訴右耳閉塞感及耳鳴2年。十年前即發現右側外耳道腫瘤,但病患未繼續治療。最近右耳疼痛加劇,於是至本院求診。理學檢查發現右耳腫瘤塞滿外耳道。聽力檢查發現右耳傳導性聽障。電腦斷層發現顱底鼓室蓋破裂,發現有一粒從顱底至外耳道的腫瘤。其鑑別診斷包括外耳道腫瘤併顱底侵犯、腦膜腦膨出至外耳道。冷凍切片發現無腦組織。以乳突鑿開術移除腫瘤時發現腦脊髓液流出及腦膜纖維,乳突及上鼓室被腫瘤侵蝕。腫瘤移除後發現顱底鼓室蓋破損1 × 1.5cm,以游離顳肌皮瓣及組織膠多層次修補後,無腦膜膨出及腦脊髓液外漏。術後以第三代環孢素治療並絕對臥床及頭部抬高,病患於七日後出院,術後半年,病患預後良好,電腦斷層發現無腦膜腦膨出。因屬罕見,特提出此病例經驗,與各位先進分享。 |
英文摘要 | Meningoencephalocele of the temporal bone is rare and may be misdiagnosed. Excision and repair with a flap are often necessary. A 26-year-old woman with meningoencephalocele complained of aural fullness and tinnitus in the right ear for 10 years. Right side hearing impairment and intermittent otalgia were also noted. Examination showed a smooth mass originating in the posterior bony wall of the ear canal almost filling the external auditory canal. An audiogram revealed right side conductive hearing loss. High-resolution computed tomography of the temporal bone showed a defect in the tegmen, and soft tissue occupying the mastoid cavity, middle ear and ear canal. The patient underwent surgery to remove the tumor via a transmastoid approach. The tegmen was repaired with a multilayered technique using temporalis mucle, gelform, tissue glue and fascia. The postoperative course was smooth and her hearing improved with a normal air-bone gap. |
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