- 期刊
放射治療後之鼻咽癌病患發生蝶竇炎及小腦膿瘍
Cerebellar Abscess with Sphenoid Sinusitis in a Patient with Nasopharyngeal Carcinoma after Irradiation
摘要
鼻竇炎是很常見的疾病，然而近幾十年由於抗生素的普遍使用，鼻竇炎引發顱內併發症的病例已顯著的減少。顱內併發症的診斷需有高度的警覺，配合臨床症狀、理學檢查及影像檢查，以便早期發現，給予適當之抗生素及手術治療，來降低死亡率及後遺症。回顧過去文獻記載，鼻竇炎引起之顱內併發症，包括硬腦膜外膿瘍、硬腦膜下積膿、腦膜炎、大腦膿瘍、上矢狀竇靜脈栓塞、海綿靜脈竇栓塞及骨髓炎，至今尚無小腦膿瘍之病例報告。本例為l名44歲男性，於5年前罹患鼻咽癌，接受過放射線治療，主訴頭痛、發燒、步態不穩、複視及全身倦怠約有7日。核磁共振影像顯示蝶竇黏膜壁增厚發炎，至左側海綿竇、橋腦前池(Pre-pontine cistern)及環池(ambient cistern)也有發炎現象，並在左側小腦形成一個約3×2.5×2cm之膿瘍。給予抗生素治療，並由神經外科做左側枕骨下顱骨切除術引流小腦膿瘍，同時由本科經鼻竇內視鏡做蝶竇切開術引流蝶竇積膿，術後恢復情況良好，電腦斷層追蹤發現蝶竇腔積膿已引流，小腦膿瘍亦已吸收。於門診追蹤l年，並無復發現象。
並列摘要
Due to widespread use of antibiotics, the incidence of intracranial complications of paranasal sinusitis (ICPS) has dramatically decreased in recent decades. The diagnosis of ICPS requires detailed evaluation of clinical symptoms, physical examination and appropriate imaging of head, neck and paranasal sinuses. Treatment includes high-dose intravenous antibiotics and surgery (neurosurgical drainage and sinus surgery). ICPS included subdural empyema, meningitis, cerebral abscess, superior sagittal sinus thrombosis, cavernous sinus thrombosis and osteomyelitis. There is no cerebellar abscess reported so far. A 44-year-old male patient who underwent radiotherapy for treatment of nasopharyngeal carcinoma 5 years ago suffered from headache, fever, ataxia, diplopia and general weakness for 7 days. Magnetic resonance imaging findings include evidence of sphenoid sinusitis, extending to left cavernous sinus, prepontine cistern, ambient cistern and cerebellum. A cerebellar abscess measuring about 3×2.5×2cm in size was found. Antibiotic therapy and surgical intervention including suboccipital craniectomy and sphenoidotomy were performed. The patient recovered well without local recurrence and neurologic sequelae after one year of follow-up.
延伸閱讀
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