nasal meningoencephalocele
Introduction
Brief introduction of nasal meningeal brain swelling Encephalomeningoceleinnose is a congenital disease that is rare in clinical practice and there is no exact statistics on its incidence. In view of its frequent occurrence in neonates and children, and often in the otolaryngology department, it should be taken seriously. The disease is a congenital malformation of the meninges and part of the brain tissue through the undeveloped or calcified nasal bones and sputum to the extracranial. It may also be that the ossification of the membrane-like bone and the internal cartilage-like bone junction of the craniofacial surface is inconsistent, and the connection is weak, so that the meninges bulge from there. Surgical treatment can often receive better results, surgical approach and improper treatment can cause cerebrospinal fluid meningitis. Transnasal incision can cause leakage of cerebrospinal fluid and meningitis. basic knowledge Sickness ratio: 0.0001% Susceptible population: more common in newborns and children Mode of infection: non-infectious complication:
Cause
Nasal meningeal brain swelling
The disease is a congenital malformation of the meninges and part of the brain tissue through the undeveloped or calcified nasal bones and sputum to the extracranial. It may also be that the ossification of the membrane-like bone and the internal cartilage-like bone junction of the craniofacial surface is inconsistent, and the connection is weak, so that the meninges bulge from there.
A defect in the tibia caused by various causes. Nasal meningeal brain swelling is a congenital malformation of the failure of the formation of the iliac crest during embryonic period. Regarding how bone defects are formed, opinions are still inconsistent. Pollock is integrated into five hypotheses: 1 The closure of the sieve plate around the olfactory nerve fails. 2 The ventricular pressure increases during the embryonic period, which drives the brain tissue to bulge. 3 neuroectodermal leaves are incompletely separated. 4 craniopharyngioma remains, sphenoid dysplasia. 5 sphenoidal ossification center development failure. Among them, neuroectodermal insufficiency and ossification failure have been accepted by most scholars. In addition, intracranial or intraorbital inflammation and tumor erosion trauma and surgery caused by the loss of the tibia can also be secondary to meningococcal brain swelling.
Prevention
Nasal meningeal bulging prevention
With the routine application of fetal ultrasound and alpha-fetoprotein detection in maternal blood, brain bulging can be diagnosed in the uterus, which is important for determining whether to terminate pregnancy. Fetal ultrasonography can detect large brain bulging and easy to detect the presence or absence of substantial tissue in the sac. Hydrocephalus is not often found in prenatal ultrasound. In fact, hydrocephalus rarely occurs at birth, usually after the repair of the posterior cranial brain. In ultrasonography, attention is paid to brain tumors that are identified in the skull, scalp, or high neck segment. These lesions are less common than brain swelling. A necessary condition for the production of abnormal alpha-fetoprotein is leakage of tissue fluid and cerebrospinal fluid. If the lesion is completely epithelialized, even if the skin is poorly developed, the alpha-fetoprotein levels in maternal blood and amniotic fluid are normal.
Complication
Nasal meningeal bulging complications Complication
Congenital meninges-brain bulging can be associated with other developmental abnormalities.
Symptom
Nasal meningeal bulging symptoms Common symptoms Nasal secretions increased nasal congestion
1, nasal appearance
Neonatal manifestations have a rounded "tumor" at or near the midline of the outside of the nose. The surface is smooth and increases with age. When the crying or compression of the meridian meridians, the "lumps" become larger, but if the bone defects are small, the performance is not obvious. Watery nasal secretions are important signs.
2, nasal type
Neonatal nasal aeration, difficulty in breastfeeding, smooth surface "tumor" in the nasal cavity or nasopharynx, the base of which is located at the top of the nose.
Examine
Nasal meningeal brain swelling
1. X-ray: The small anterior bulge of the brain is difficult to show the outer wall and the dome. When the large area of the bone is missing, the X-ray of the orbital ridge is a low density or "cavity sign".
2, ultrasound: ultrasound is generally due to the attenuation of the acoustic energy of the dura mater, can not show the intracranial situation, can only show the compression of the soft tissue inside the sputum (B-ultrasound) and the single high-reflection after the ball (A super), real-time scanning can show the ball After the organization beats. Due to the significant attenuation of the acoustic energy of the brain tissue, ultrasound can show multiple repetitive waves behind the ball.
3, CT: Due to the CT volume problem, the horizontal axis CT is difficult to display the location of the bone loss, unless the bone loss range is large, the coronary CT generally shows good. The large area of the sphenoid sphenoid wing lacking CT and X-ray showed good, and the brain tissue was invaded into the sac. Because of the degree of defect in the dome and the outer wall, especially when the area is large, coronary CT can show similar lesions in the anterior segment during the anterior scan, which is easy to be misdiagnosed.
4. MRI: It can be seen that the bulged brain tissue is continuous with the intracranial brain tissue. The intrathoracic cerebrospinal fluid T1WI is low signal and T2WI is high signal.
Diagnosis
Diagnosis and identification of nasal meningeal brain swelling
diagnosis
1, typical clinical symptoms and signs:
(1) Pay attention to the size of the mass at birth, the future growth, whether there is impulse in the block when crying, whether it has broken or not; whether the skull is increasing at the same time.
(2), physical examination: pay attention to the size of the head circumference, mental development. In the base of the nose, measure whether the distance between the two eyelids is widened, whether it is a triangular eye, or whether there is a hemiplegic; in the sacral cavity, check the visual acuity, and whether there is eyeball protrusion.
(3), local examination: the location and size of the cystic mass, the width of the base. The mass is not puncture and no biopsy is performed. Use transillumination to find out whether it is a simple cystic mass or a brain tissue.
2, auxiliary inspection performance
X-ray examination in the anterior meninges-brain bulging, the photographic position using the mouth 45 ° after the anterior position can be found in the sieve plate bone defect. After the posterior bulging at 20°, the anterior X-ray film showed small anterior cranial fossa, large cranial fossa, large sphenoid bone, small wing bone loss or enlarged bone and bone fracture. Ultrasound examination showed a pulsatile cystic mass that was compressible. CT scans revealed bone loss and lower or high-density block penetration to extract clear fluids that were confirmed by routine and biochemical analysis as cerebrospinal fluid. The lumbar puncture injects pigment and stains the cerebrospinal fluid in the mass. Gas is injected into the eyelid mass, and intracranial air bubbles can be seen on the X-ray film. All the above examinations indicate that the tumor in the sac is communicating with the intracranial.
Differential diagnosis
The anterior meningeal bulge needs to be differentiated from the lacrimal sac cyst: the former spontaneous vibration and the positional X-ray and CT can find the bone hole.
