안와 상벽의 성장성 두개골절에 의한 재발성 뇌막염 - 증례 보고 -
Recurrent Meningitis due to Growing Basal Skull Fracture of Orbital Roof - A Case Report -
소속 상세정보
이규석
고용/백광흠/김재민/김영수/김충현/오성훈/오석전/김광명
KMID : 0359819980270040501
Abstract
서론
소아의 성장성 두개골 골절은 심한 두부 외상후 0.03∼0.05%에서 발생하는 매우 드문 합
병증이며, 이 곳을 통한 뇌수막염이 반복되는 경우는 매우 드문 일이다. 뇌막염은 항생제로
치료하는 것이 원칙이지만 감염이 자주 반복되면서 해부학적으로 원인 부위가 확인된 경우
에는 원인 부위에 대한 수술적 처치가 따라야 한다
저자들은 안와 상벽에 발생한 성장성 두개골 골절에 의하여 수 차례 재발된 세균성 뇌막
염 일례를 수술적 치료하고 문헌고찰과 함께 보고한다.
#초록#
A 6-year old boy was admitted with high fever and redness of the right eyelids and
the surrounding area. He had previously suffered cerebral contusion, basal skull fracture
and pneumocephalus following a traffic accident which required six months'
hospitalization. Since then, and prior to admission, he had twice suffered probable
bacterial meningitis ad had been treated at an outstanding hospital. At the time of this
admission, the patients again developed high fever, with redness of the right eyelid and
surrounding area. His symptomatology suggested bacterial meningitis and cerebrospinal
fluid culture revealed Streptococcus pneumoinae sensitive to penicillin. In accordance
with the clinical course of meningitis and accompanying sinusitis, the appropriate
antibiotic and its duration of usage were determined.
Recurrent episodes of bacterial meningitis in this clinical raised the possibility of
anatomical defect as an s contributory factor. Computerized tomographic(CT)
cisternography suggested leakage of cerebrospinal fluid and revealed herniated frontal
brain tissue protruding through a gap in the right frontal skull base, three dimensional
CT(3-D CT) confirmed this defect, which was 3×4cm in size.
After recovery from meningitis, surrey to prevent recurrent meningitis, was performed
To locate pathologic areas, the subfrontal approach, involving bicoronal skin incision
and bifrontal bone flap was used. Multiple fracture lines and a large bony defect on the
orbital roof were observed, together with a dural defect, through which cerebromalatic
tissue was herniated as encephalocele, Using lyophilized dura, the dural defect was made
watertight ; the bony defect was packed with autologous fats and covered with titanium
mesh. The patient improved after surgery.
Recurrent meningitis with anatomical pathologic focus after head trauma requires
surgical intervention.
키워드
Meningitis; Encephalocele; Growing skull fracture; Surgery;
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