Functional Endoscopic Sinus Surgery Complicated with Intracranial Hemorrhage

顱內傷害是功能性內視鏡鼻竇手術少見但嚴重的併發症。它需要迅速的診斷和適當的處置來避免可能的悲慘後果。一名48歲女性病患罹患痰中帶血已有數月。電腦斷層檢查疑似右上頷竇黴菌感染，因此住院接受右側功能性內視鏡鼻竇手術。手術中發現在臨近中鼻甲的前顱底處有受到傷害，但並沒有明顯的腦脊髓液外溢或明顯的出血。術後傷口用Gelform®填塞。不幸，4日後病患高燒且抱怨頭痛，電腦斷層檢查發現蜘蛛網膜下出血。病患接受支持性治療，追蹤6個月後，病患不再頭痛也沒有任何神經學後遺症。這個病例提醒我們在執行功能性內視鏡鼻竇手術時如果傷害到前顱底有可能會導致顱內出血。

關鍵字

併發症；功能性內視鏡鼻竇手術；顱內出血；鼻及鼻竇炎

並列摘要

Intracranial injury is a rare but major complication of functional endoscopic sinus surgery (FESS). Rapid diagnosis and adequate management are necessary in such cases to avoid a possible disastrous result. A 48-year-old female had complained of bloody sputum for a few months. Computed tomography (CT) suspected fungal infection of the right maxillary sinus, and she was admitted to undergo right FESS. During the operation, accidental inury of the anterior skull base was noted lateral to the middle turbinate, but there was no apparent cerebrospinal fluid leak or active bleeding. The wound was packed with Gelform® as usual. Unfortunately, the patient developed severe headache with fever 4 days later. CT showed subarachnoid hemorrhage. Supportive treatment was given. Six months later, the patient was doing well, and had no headache or any neurological sequelae. This case reminds us of the possibility of intracranial hemorrhage when the skull base is injured during FESS.

並列關鍵字

complication ； functional endoscopic sinus surgery ； intracranial hemorrhage ； rhinosinusitis

國際替代計量

Functional Endoscopic Sinus Surgery Complicated with Intracranial Hemorrhage

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