摘要
目的总结神经外科对于颅眶沟通异物病例的治疗经验及并发症。方法回顾性分析28例颅眶沟通异物患者的临床资料，28例中金属异物13例，植物性异物5例，玻璃、塑胶类及其他性质异物10例。视神经损伤13例，眶尖综合征11例。脑脊液鼻漏13例，脑脊液眼漏3例，肢体偏瘫2例。28例均进行头颅CT检查，并加作眼眶水平及冠状位CT；对金属异物病例行DSA检查，非金属异物行MRA检查。对22例患者进行了额眶开颅异物取出术，6例行直接拔除术。术后给予抗感染及营养神经治疗。结果自眶顶入颅的异物，术后患者恢复良好；自眶上裂刺入的异物，术后偏瘫2例，眶尖综合征6例。结论颅眶沟通异物患者需早期诊治，避免漏诊。异物取出术应避免遗漏，直接拔除术前应详尽检查与颈内动脉关系。拔除异物对患者损伤较小，但术后应密切观察病情变化。
Objective To discuss the benefits and complications of the neurosurgical therapy in transorbital intracranial foreign bodies. Methods The clinical data of 28 cases of transorbital intracranial foreign bodies, metallic in 13 cases, vegetal 5 cases, and vitreous, plastic and other kinds in 10 cases, were analyzed retrospectively. Optic nerve injury was found in 13 cases, orbital apex syndrome in 11 cases; CSF rhinorrhea in 13 cases, CSF orbital leak in 3 cases, and hemiplegia in 2 cases. All the patients underwent head CT scan, and orbital horizontal and coronal CT scan. The patients with metallic foreign bodies had DSA exams, and the non-metallic cases had MRA scans. 22 cases had orbital-frontal craniotomy and foreign body resection, and 6 cases had direct foreign body extraction. All the cases received antibiotic and nerve nutritional therapy postoperatively. Result The cases in which the foreign bodies came from the orbital roof into the skull recovered well postoperatively; and the cases in which the foreign bodies came from the superior orbital fissure into the skull showed hemiplegia （n = 2 ） or orbital apex syndrome （n = 6 ） postoperatively. Conclusion Transorbital intracranial foreign body should be diagnosed in early stage to avoid missed diagnosis. Omission should be avoided during resection of the foreign body. The relationship between the foreign body and internal carotid artery should be examined carefully before the extraction. Direct extraction of foreign body causes less injury, and patients＇ condition should be followed up.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第25期1737-1741,共5页
National Medical Journal of China
关键词
异物
眼眶
颅内穿通
Foreign body
Orbit
Intracranial penetration
