PDF(Pubmed)
Abstract：
BACKGROUND: Recent anatomical studies have reported the feasibility of the endoscopic endonasal approach to the middle fossa. However, its clinical applicability has been discussed in only a few cases. This article describes the case of a middle fossa epidural abscess successfully drained through a fully endoscopic endonasal corridor and discusses the key technical points.
METHODS: The authors describe an 8-year-old boy who presented with worsening headache, fatigue, emesis, and fever and was diagnosed with a left middle fossa epidural abscess associated with sphenoid sinusitis. Following endoscopic sinus surgery performed by a rhinologist, the middle fossa was accessed by removing the maxillary strut through the transmaxillary transpterygoid corridor. Complete drainage of the abscess was confirmed on postoperative magnetic resonance imaging. The patient tolerated the surgery without neurological deficit and demonstrated prompt symptom improvement. He was discharged home after completing a 6-week course of antibiotic therapy and remained free from recurrence at 1 year following surgery.
CONCLUSIONS: The endoscopic endonasal approach may be applicable to a middle fossa epidural abscess, resulting in prompt clinical improvement. The maxillary strut is a key structure for entering the middle fossa. https://thejns.org/doi/10.3171/CASE24288.
METHODS: The authors describe an 8-year-old boy who presented with worsening headache, fatigue, emesis, and fever and was diagnosed with a left middle fossa epidural abscess associated with sphenoid sinusitis. Following endoscopic sinus surgery performed by a rhinologist, the middle fossa was accessed by removing the maxillary strut through the transmaxillary transpterygoid corridor. Complete drainage of the abscess was confirmed on postoperative magnetic resonance imaging. The patient tolerated the surgery without neurological deficit and demonstrated prompt symptom improvement. He was discharged home after completing a 6-week course of antibiotic therapy and remained free from recurrence at 1 year following surgery.
CONCLUSIONS: The endoscopic endonasal approach may be applicable to a middle fossa epidural abscess, resulting in prompt clinical improvement. The maxillary strut is a key structure for entering the middle fossa. https://thejns.org/doi/10.3171/CASE24288.
摘要：
背景：最近的解剖学研究报道了鼻内镜下中窝入路的可行性。然而,仅在少数情况下讨论了其临床适用性。本文介绍了中窝硬膜外脓肿通过完全内镜经鼻道成功引流的病例，并讨论了关键技术要点。
方法：作者描述了一个8岁的男孩，他头痛恶化，疲劳,呕吐,和发烧，被诊断为左中窝硬膜外脓肿与蝶窦炎相关。鼻内镜手术后，通过经上颌翼状骨道去除上颌支柱，进入中窝。术后磁共振成像证实脓肿完全引流。患者耐受手术，无神经功能缺损，症状迅速改善。他在完成为期6周的抗生素治疗后出院，并且在手术后1年没有复发。
结论：内镜经鼻入路可能适用于中窝硬膜外脓肿，导致临床迅速改善。上颌支柱是进入中窝的关键结构。https://thejns.org/doi/10.3171/CASE24288.
方法：作者描述了一个8岁的男孩，他头痛恶化，疲劳,呕吐,和发烧，被诊断为左中窝硬膜外脓肿与蝶窦炎相关。鼻内镜手术后，通过经上颌翼状骨道去除上颌支柱，进入中窝。术后磁共振成像证实脓肿完全引流。患者耐受手术，无神经功能缺损，症状迅速改善。他在完成为期6周的抗生素治疗后出院，并且在手术后1年没有复发。
结论：内镜经鼻入路可能适用于中窝硬膜外脓肿，导致临床迅速改善。上颌支柱是进入中窝的关键结构。https://thejns.org/doi/10.3171/CASE24288.
