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颅内硬膜外脓肿

Authors
Daniel J Sexton, MD
John H Sampson, MD, PhD, MBA
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Anna R Thorner, MD
Translators
何洋, 主治医师

引言

硬膜外脓肿是一种罕见但重要的中枢神经系统(central nervous system, CNS)化脓性感染[1]。局限在头颅或脊柱骨骼界线内的脓肿可扩大至压迫脑或脊髓，并引起严重症状、永久性并发症甚至死亡。及时的诊断和恰当的治疗在多数情况下都可以防止并发症并治愈患者。硬膜外脓肿的诊断及治疗(通常包括脓肿抽吸或引流的手术操作)从现代影像学技术的诞生中获益良多，如CT和MRI，尤其是MRI[2-4]。

硬膜外脓肿有两种不同的类型：硬脊膜外脓肿(spinal epidural abscess, SEA)和颅内硬膜外脓肿(intracranial epidural abscess, IEA)。SEA更为常见，其与IEA的发生率之比为9:1。区分两者的依据是它们在CNS中的解剖学位置不同以及症状和自然病程中存在一些差异。IEA比SEA少见，进展过程也比较缓慢。但与SEA一样，IEA也是严重感染，需要最佳治疗来预防并发症。

本文将总结IEA的流行病学、微生物学、临床表现、诊断和治疗。SEA、脑脓肿和细菌性脑膜炎将单独讨论。 (参见“硬膜外脓肿”和“脑脓肿的发病机制、临床表现和诊断”和“细菌性脑脓肿的治疗及预后”和“成人细菌性脑膜炎的流行病学”和“细菌性脑膜炎的发病机制和病理生理学”和“成人急性细菌性脑膜炎的临床特征和诊断”和“成人细菌性脑膜炎的初始治疗和预后”和“成人特定病原体所致细菌性脑膜炎的治疗”和“成人细菌性脑膜炎的神经系统并发症”)

解剖学

硬脑膜是颅骨的内衬并直接贴附于颅骨。因此，正常情况下并不存在实际的硬膜外隙。肿瘤、出血、炎性肿块或脓液在扩大中产生的压力可以撑开潜在的硬膜外隙。这需要使牢固贴附的硬脑膜与颅骨分开，因此，IEA往往扩大速度缓慢、呈圆形且相当局限。

发病机制与病理学

病原体播散至潜在硬膜外隙的方式通常为邻近感染灶的直接蔓延，或创伤或神经外科手术造成的侵染。病原体也可通过额骨板的静脉孔入侵至该腔隙而不引起额骨骨髓炎。侵入硬膜外腔后，细菌会引起炎症以及脓液或肉芽组织形成，它们会逐渐将贴附在骨骼上的坚韧硬脑膜与颅骨内板分开。

             

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-16.
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