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

陳甘斌(Kan-Ping Chen) ； 陳培榕(Peir-Rong Chen) ； 周昱甫(Yu-Fu Chou)

《慈濟醫學雜誌》 18卷2期 (2006/04) Pp. 149-153

https://doi.org/10.6440/TZUCMJ.200604.0149

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。

關鍵字

腦膜腦膨出 ； 乳突鑿開術 ； 游離顳肌皮瓣 ； 多層次修補

並列摘要

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.

並列關鍵字

meningoencephalocele ； transmastoid approach ； free temporalis muscle ； multilayered closure