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首页> 外文期刊>Otology and neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology >Temporal Bone Meningo-Encephalic-Herniation: Etiological Categorization and Surgical Strategy
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Temporal Bone Meningo-Encephalic-Herniation: Etiological Categorization and Surgical Strategy

机译：颞骨脑膜脑脑疝：病因分类和外科策略

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Objective:To study the clinical presentation, intraoperative findings and surgical management in meningo-encephalic-herniation (MEH) based on the etiology.Study Design:A retrospective clinical study and is a follow-up on the previously published report in 2009.Setting:A quaternary referral otology and skull base centerPatients and Methods:The inclusion criteria were intraoperatively verified MEH in patients with a minimum follow-up of 12 months, which yielded 262 operated ears. The data were extracted regarding demographics, laterality, clinical presentation, past surgeries, contralateral-ear condition, intraoperative findings, complications, recurrences, revision-surgeries, audiometric-data, and follow-up.Results:The mean age at surgery was 49.7 years with the involvement of right-ear in 53.8% of patients. Lesions were categorized based on the etiology as chronic-otitis-media with/without cholesteatoma-MEH (COM/CHOL-MEH)-47.7%, iatrogenic-MEHs -20.9%; traumatic-MEHs -8% and spontaneous-MEHs -23.3%. At presentation, hearing loss (100 and 98.2%) and otorrhea (65.6 and 49.1%) were predominant in COM/CHOL-MEHs and iatrogenic-MEHs, respectively. On the other hand, meningitis (23.9 and 14.3%) and cerebrospinal fluid-leak (52.4 and 42.8%) were more pronounced in spontaneous and traumatic MEHs, respectively. Surgical approaches included 1) transmastoid, 2) middle-cranial-fossa-approach, 3) combined, and 4) middle-ear-obliteration (MEO) techniques. A total of 52.8% of COM/CHOL-MEHs and 49.1% of iatrogenic-MEHs underwent MEO. Middle-cranial-fossa approach was predominantly used in spontaneous-MEHs (52.5%) and traumatic-MEHs (38.1%). The defect was mostly single (75.2%). Smaller, multiple, bilateral lesions were more common in spontaneous-MEHs with tegmen-tympani involvement (57.4%).Conclusion:Incorporating etiology into MEHs is a key-step that can be used as a guidance in choosing the right surgery. MEO is a part of armamentarium, and should be used whenever needed, if the objective is performing a definitive surgery.
机译：目的：基于病因研究，研究脑内脑脑激发（MEH）的临床介绍，术中发现和外科手术管理.STUDY设计：回顾性临床研究，是2009年之前发表的报告的后续行动.Setting：季甲术耳科和颅底中心浇注和方法：纳入标准是术中验证的患者，患者最低随访12个月，其耳朵产生262个耳朵。提取数据关于人口统计学，横向，临床介绍，过去的手术，对侧耳病症，术中发现，并发症，再次发生，修正外科，听力数据和随访。结果：手术的平均年龄为497岁右耳参与53.8％的患者。基于病因的病因分类为慢性 - 中耳炎 - 含有/不含胆怯瘤-MEH（COM / CHOL-MEH）-47.7％，认识性-MEHS -20.9％;创伤-MEHS -8％和自发性-MEHS -23.3％。在演示文稿中，听力损失（100和98.2％）和耳喉（65.6和49.1％）分别在COM / CHOL-MEHS和Iaorrogenic-MeH中占主导地位。另一方面，脑膜炎（23.9和14.3％）和脑脊液泄漏（52.4和42.8％）分别在自发性和创伤性MeH中更加明显。包括1）传递曲线，2）中间颅骨 - 浮雕 - 方法，3）组合，4）中耳闭合（MEO）技术。总共52.8％的COM / CHOL-MEHS和49.1％的IATONICIC-MEHS接受MEO。中颅 - 浮肿方法主要用于自发性-MEHS（52.5％）和创伤性 - MEHS（38.1％）。缺陷大多是单身（75.2％）。 Tegmen-Tympani参与的自发性Mehs较小，双侧病变更常见（57.4％）。结论：将病因纳入MEHS是一种关键步骤，可作为选择右手术的指导。 Meo是武器的一部分，如果目标正在进行明确的手术，则应在需要时使用。

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