UNASSIGNED: Retrospective case series.
METHODS: Tertiary referral centers.
METHODS: Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM.
METHODS: Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation.
METHODS: Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery.
RESULTS: Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1).
CONCLUSIONS: Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy.
■回顾性病例系列。
方法:三级转诊中心。
方法:患者(N=11)经影像学检查或术中鉴定,有症状的FCM。
方法:手术修复脑脊液(CSF)漏和脑膜膨出与观察。
方法:介绍(包括症状,射线成像,和合并症),管理(包括手术方法,包装技术,使用腰部排水管),临床结果(脑脊液渗漏的控制,脑膜炎,面神经功能),和翻修手术。
结果:患者出现自发性脑脊液漏(n=7),传导性(N=11)和感音神经性听力损失(n=3),非位置性间歇性眩晕(n=3),头痛(n=4),和复发性脑膜炎(n=1)。我们系列的危险因素包括肥胖(n=4),Chiari1畸形(n=1),和头部外伤(n=2)。10例患者的颞骨非对比计算机断层扫描和磁共振成像对FCM呈阳性。八名患者通过经乳突入路手术治疗(n=4),经乳突和中窝联合(N=3),或单独的中窝(n=1);观察保守地管理了三个。术后并发症包括面神经麻痹加重(n=1),复发性脑膜炎(n=1),和持续的CSF泄漏,需要修正(n=1)。
结论:面神经脑膜膨出罕见,表现可变,通常包括脑脊液耳漏。管理可能具有挑战性,并受到症状学和合并症的指导。FCM的危险因素包括肥胖和头部创伤,Chiari1畸形可能伴有非特异性耳科症状,在某些情况下,脑膜炎和面神经麻痹.分层手术修复的成功率很高;然而,这可能是复杂的面部麻痹恶化。