非典型顱底骨髓炎：單一醫學中心的臨床治療經驗

A Single-Institute Experience in the Treatment of Atypical Skull Base Osteomyelitis

吳璟雯(Ying-Wen Wu) ； 邱于容(Yu-Jung Chiu) ； 江榮山(Rong-San Jiang) ； 梁凱莉(Kai-Li Liang)

《台灣耳鼻喉頭頸外科雜誌》 46卷6期 (2011/12) Pp. 318-322

https://doi.org/10.6286/2011.46.6.318

摘要

背景：非典型顱底骨髓炎發生於免疫不全者，為耳源性或鼻源性的感染造成的中顱部骨髓炎，臨床的表現不同於典型惡性外耳炎。非典型顱底骨髓炎臨床不常見，治療也相當棘手，本研究收集近年經歷的顧底骨髓炎患者並作分析。方法：收集2003年1月至2010年12月診斷為非典型顱底骨髓炎的患者，診斷依據包括症狀、身體檢查、病理報告、電腦斷層、核磁共振、核醫和實驗室檢查，所有患者均沒有惡性外耳炎的症狀或病史。分析患者的臨床表現及預後。結果：共19名患者於此期間診斷為非典型顱底骨髓炎，其中鼻咽癌9名、鼻咽癌併糖尿病2名、慢性腎衰竭1名、糖尿病6名、肝硬化1名。14名患者有鼻及鼻竇炎、6名有鼻咽部或顱底膿瘍、13名患者有中耳炎成乳突炎、6名有積液性中耳炎、11名有顱底放射骨壞死。非典型顱底骨髓炎臨床表現變化大，除發燒、頭痛外，19名患者均有腦神經或腦血管病變。所有患者均接受抗生素治療， 3名患者並接受高壓氧治療，8名患者接受鼻內視鏡引流清創，4名患者接受內視鏡引流清創及高壓氧治療。鼻咽癌患者中，6名因敗血症、5名因主動脈破裂過世，8名沒有鼻咽瘤的患者中，3名康復，其餘5名存活但有後遺症。結論：非典型顱底骨髓炎診斷及治療不易，鼻咽癌合併顱骨壞死的患者尤其預後不佳。（台耳醫誌 2011；46：318－322）

關鍵字

顱神經病變 ； 鼻咽癌 ； 骨髓炎 ； 放射骨壞死 ； 顱底

並列摘要

BACKGROUND: Atypical skull base osteomyelitis results from otogenic or rhinogenic infection in immunocompromised patients. The clinical manifestation of atypical skull base osteomyelitis is different from that induced by malignant otitis externa. It is rare and difficult to treat. The purpose of this study was to analyze the clinical manifestation and prognosis of patients with atypical skull base osteomyelitis.METHODS: From January 2003 to December 2010, patients diagnosed as atypical skull base osteomyelitis were enrolled in our hospital by chart review. The diagnosis of atypical skull base osteomyelitis was based on clinical history, physical, nasoendoscopic and pathologic examination, image studies (computed tomography, MRI), nuclear scans, and laboratory tests. None of the patients had apparent history of malignant otitis extema. Their clinical manifestation, treatment methods and outcome were analyzed.RESULTS: A total of 19 patients were enrolled in this study. All were immunocompromised including patients with post-irradiated nasopharyngeal carcinoma, end stage renal disease, diabetes, or liver cirrhosis. There were 14 patients with rbinosinusitis, 6 with nasopharyngeal or skull base abscess. Thirteen patients had chronic otitis media or mastoiditis, 6 had otitis media with effusion, and 11 had skull base osteoradionecrosis. The clinical manifestation included general infectious symptoms, multiple cranial neuropathies and cerebral vascular accidents. All patients received intravenous antibiotics treatment, 3 received hyperbaric oxygen therapy, 8 received endoscopic debridement, and 4 received endoscopic debridement and hyperbaric oxygen therapy. All patients with nasopharyngeal carcinoma died. The others stay alive but 4 of them have neurologic sequelae.CONCLUSION: Atypical skull base osteomyelitis is difficult to diagnosis and treat. The prognosis of patients with post-irradiated nasopharyngeal carcinoma is very poor. (J Taiwan Otolaryngol Head Neck Surg 2011; 46:318-322)

並列關鍵字

cranial neuropathies ； nasopharyngeal carcinoma ； osteomyelitis ； osteoradionecrosis ； skull base