Ozveren M F, Kaplan M, Topsakal C, Bilge T, Erol F S, Celiker H, Akdemir I, Uchida K
Department of Neurosurgery, Firat University Medical Faculty, Elazig, Turkey.
Neurol Med Chir (Tokyo). 2001 Jun;41(6):313-7. doi: 10.2176/nmc.41.313.
A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. Neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca++ and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH2O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extra-osseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca++ mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation.
一名39岁女性因左侧头痛和流涕3个月入院，后来证实为脑脊液（CSF）。神经系统检查除双侧视乳头水肿外未发现异常。神经影像学显示嗅神经穿过的筛板孔扩大，以及空蝶鞍和大脑皮质萎缩。骨密度测定显示骨质减少。脑脊液钙水平和血甲状旁腺激素水平升高。脑脊液压力为280mmH₂O。进行双侧额部开颅术以暴露前颅窝。确认筛板孔扩大，并在蛛网膜上发现骨外钙化岛。在前颅窝底部硬膜内两侧用筋膜移植物和纤维蛋白胶进行修复。1年随访时未发现脑脊液漏。自发性脑脊液漏可能是由于骨质中钙动员导致筛板孔扩大以及假性脑瘤引起的，而非蛛网膜颗粒处脑脊液吸收不良导致的脑积水程度，后者被骨外钙质积聚所阻塞。
