- 期刊
Traumatic Tension Pneumocephalus─Intracerebral Pneumatocele : A Case Report
受傷性壓力氣腦─腦內氣囊
摘要
壓力性氣腦屬於神經外科急症，處理上宜早期斷及治療。在此介紹一18歲男性病例患頭部外傷併額骨右側骨折及額葉出血，經由開顱手術取出血塊，三個月後發生腦脊髓鼻漏，頭痛，嘔吐，電腦斷層檢查証實壓力性氣腦及放射性同位素腦池造影檢查發現腦脊髓液由篩竇流出，經由再次開顱手術後成功的完成硬腦膜的修補，而瘻管則以顱骨膜肌肉充填。
關鍵字
無資料並列摘要
An 18-year-old Chinese man, suffering from head injury in a motorcycle accident, with right traumatic frontal intracerebral hemorrhage and frontal bone fractures, underwent emergency craniotomy with evacuation of hematoma at a local out-patient clinec and three months later, he sufferred from CSF rhinorrhea. Headache, nausea and vomiting developed a week prior to admission. Tension pneumocephalus was diagnosed by computed tomography (CT) scan and plain skull X-ray. The fistula tract of the ethmoid sinus was investigated by radioisotope albumin (RISA) cisternography. The patient subsequently underwent emergency craniotomy for decompression. During the operation, we found that the intracerebral pneumatocele in the right frontal lobe communicated with the ipsilateral ethmoidal sinus, through which extracranial air ingressed and CSF egressed. This pneumatocele was unroofed and the fistula was temponaded by pericranial muscles and the Gelfomas sealed by tissue glue. Finally duraplasty was performed. Follow-up CT scan revealed that pneumocephalus subsided and the patient was cured of CSF rhinorrhea on discharge. As a surgical emergency, tension pneumocephalus can be successfully treated only by early diagnosis and early treatment.