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  • Title: [Retrospective clinical analyses of otogenic intracranial infections].
    Author: Chai L, Hu J, Mao YJ, Li QC, Zhang ZL.
    Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2018 Oct 07; 53(10):770-775. PubMed ID: 30347537.
    Abstract:
    Objective: To investigate the clinical characteristics and treatment options for otogenic intracranial infections. Method: Clinical records of all the patients of otogenic intracranial infections admitted to the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were retrospectively analyzed. Their clinical presentations, radiological findings, culture results, and medical and surgical therapy modalities, as well as treatment outcomes were studied. Results: Sixteen cases were identified. The majority of the otogenic patients had a history of cholesteatoma, other rare events included congenital cerebrospinal fluid otorhinorrhea, Gorham-Stout disease and after radiation therapy for nasopharyngeal carcinoma. Meningitis, cerebral venous thrombosis and brain abscess were the primary intracranial infection. Eight patients had received modified radical mastoidectomy at least one time. Results of routine culture for cerebrospinal and pus samples had high negative rate. All patients received initial empirical broadspectrum intravenous antibiotics therapy. Four cases of brain abscesses were drained or excised at the same time for otologic surgery. The mortality rate was 6.25% (1 case). Conclusions: Cholesteatoma is still the most commonly primary disease of otogenic intracranial complications. Diagnosis and treatment of otogenic intracranial infections require multidisciplinary cooperation. Surgical intervention for primary ear lesions and intracranial abscess is still the main option in the treatment of otogenic intracranial infections. 目的： 探讨耳源性颅内感染的临床特点与治疗选择。 方法： 回顾性分析2008—2016年浙江大学医学院附属第一医院治疗的16例耳源性颅内感染患者的临床资料，总结其临床表现和治疗方法。 结果： 耳部原发疾病包括中耳胆脂瘤8例，岩尖胆脂瘤及慢性化脓性中耳炎各2例，隐匿性中耳炎、Mondini畸形致先天性脑脊液耳鼻漏、Gorham综合征以及鼻咽癌放疗后分泌性中耳炎各1例。8例患者出现1种颅内病变，另外8例患者均存在2种及以上颅内病变。8例患者既往有耳部手术史，有6例曾行2次乳突手术。病原学检查中，脑脓肿脓液和脑脊液样本培养的阳性率较低，抗生素治疗主要以经验性用药为主。随访1～9年，3例患者行保守治疗，1例治愈，1例症状改善，1例死亡；13例患者在炎性反应得到控制情况下接受耳部病灶手术，有4例同时行颅内脓肿的手术，1例颞叶脑脓肿切除术后2个月脓肿复发，其余病例颅内感染均治愈。 结论： 胆脂瘤仍是耳源性颅内感染最常见的原发疾病，耳源性颅内感染的及时诊治需要多学科协作，在目前抗生素广泛应用的情况，耳部原发灶与颅内脓肿的手术处理仍是主要的治疗方式。.
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