化脓性额窦炎合并镰膜脓肿1例的手术治疗

D. M. Khatomkin, A. Vorobev, I. A. Vorobev, N. Komissarova, A. V. Kobelev
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To report the case of subdural empyema of rare localization – in the left part of the interhemispheric fissure and supratentorial space, to demonstrate the effectiveness of prolonged continuous flow drainage in treatment of the subdural empyema in this particular case.Materials and methods. 16‑year‑old patient was admitted into the neurosurgical department of the 1‑st Republican clinical hospital of the Izhevsk city with pronounced general infectious and meningeal syndrome and paresis of the muscles of his right shin and foot. CT scans revealed frontal sinusitis and subdural empyema of the left part of the interhemispheric fissure and the supratentorial space. In addition to intravenous antibacterial therapy with vancomicyn and Meronem bifrontal cranioectomy, debridement of the frontal sinus, obliteration of it’s residual cavity with free muscle graft and external drainage of the subdural empyema with following continuous irrigation during 6 days after surgery had been performed. 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摘要

背景。硬脑膜下脓肿是脑硬脑膜和蛛网膜之间积液。它们占所有颅内化脓性炎症性疾病的12 - 25%。其中70 - 80%位于脑凸区,10 - 20%位于脑镰区。在小脑幕上扩散脓液是罕见的。如果不及时治疗,包括大量抗生素治疗和硬膜下脓肿引流,大多数患者死于继发性化脓性脑膜脑炎的进展和brain.Аim脱位。报告一例罕见的局部硬膜下脓肿-左半球间裂和幕上间隙,以证明长时间连续血流引流治疗该特殊病例的硬膜下脓肿的有效性。材料和方法。16岁的患者因明显的一般感染和脑膜综合征以及右胫骨和足部肌肉麻痹被收住伊热夫斯克市第一共和国临床医院神经外科。CT扫描显示额窦炎和硬膜下脓肿左半球间裂和幕上间隙。术后6天,除万古霉素、美罗南静脉抗菌外,还行额窦清创、游离肌移植物封堵额窦残留腔、硬膜下脓肿外引流及持续冲洗。术后16天出院时,观察到一般感染和脑膜综合征完全消退。术后44天对照检查患者情况正常,无神经功能障碍。在颅骨成形术后6个月的MRI扫描中,未发现硬膜下脓肿的残余。本临床病例证明了长时间连续血流引流联合全身抗生素治疗和消除额窦内感染的主要来源对治疗罕见的镰状脑膜定位的大而深的硬膜下脓肿的有效性。
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Surgical treatment of a patient with purulent frontal sinusitis and falcotentorial empyema
Background. Subdural empyemas are accumulation of pus between the dura mater and the arachnoid mater of the brain. They represent 12–25 % of all intracranial purulent‑inflammatory diseases. 70–80 % of them are located convexitaly and 10–20 % in the area of the falx cerebri. A spread of pus on the tentorium cerebellum occurs rare. Without timely treatment, that includes massive therapy with antibiotics and drainage of the subdural empyema, most of the patients die in the result of progression of the secondary purulent meningoencephalitis and dislocation of the brain.Аim. To report the case of subdural empyema of rare localization – in the left part of the interhemispheric fissure and supratentorial space, to demonstrate the effectiveness of prolonged continuous flow drainage in treatment of the subdural empyema in this particular case.Materials and methods. 16‑year‑old patient was admitted into the neurosurgical department of the 1‑st Republican clinical hospital of the Izhevsk city with pronounced general infectious and meningeal syndrome and paresis of the muscles of his right shin and foot. CT scans revealed frontal sinusitis and subdural empyema of the left part of the interhemispheric fissure and the supratentorial space. In addition to intravenous antibacterial therapy with vancomicyn and Meronem bifrontal cranioectomy, debridement of the frontal sinus, obliteration of it’s residual cavity with free muscle graft and external drainage of the subdural empyema with following continuous irrigation during 6 days after surgery had been performed. At the time of discharge from the neurosurgical department 16 days after the operation complete regress of the general infectious and meningeal syndrome was observed.Results. On control examination 44 days after the surgery the patient’s condition was normal and he had no neurolog ical deficit. On the series of MRI scans preformed 6 months latter, after the cranioplasty, no remnants of the subdural empyema were revealed.Conclusions. This clinical case demonstrates the effectiveness of the prolonged continuous flow drainage in combination with systemic antobioticotherapy and elimination of the primary source of infection within the frontal sinus in treatment of the large and deeply situated subdural empyema of rare falcotentorial localization.
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