鼻腔内に突出した前頭洞髄膜脳瘤例

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A polyp-like mass was found in the left nasal cavity of a 5-year-old girl with acute otitis media. She had had tetanic seizures several months earlier. Coronal CT scan showed a bony defect in the left cribriform plate and a soft tissue mass in the left nasal cavity. MRI revealed brain tissue protruding into the ethmoid sinus and nasal cavity and inflammatory changes in the left maxillary and ethmoid sinuses.An operation was performed via the anterior cranial fossa after conservative therapy for sinusitis. The protruding brain tissue and surrounding dura were transected at the base. Since this lesion seemed to be related to her previous seizures, a small part of the brain substance around the base of the protrusion was removed until abnormal spikes in electroencephalogram disappeared. Then an endonasal ethmoidectomy was done under endoscopic control. The bony defect of the skull base was closed successfully with a fascia lata and galeo-pericranial flap. The postoperative course was uneventful.We emphasize that meningoencephalocele must be kept in mind in the differential diagnosis when a polyp-like mass is seen in the nasal cavity of an infant. To prevent postoperative rhinogenic intracranial infection, treatment for accompanying sinusitis such as endoscopic sinus surgery is necessary.
耳鼻咽喉科臨床学会の論文