Lefranc M, Peltier J, Demuynkc F, Bugnicourt J-M, Desenclos C, Fichten A, Toussaint P, Le Gars D
Department of Neurosurgery, CHU d'Amiens, 5, place Victor-Pauchet, 80054 Amiens cedex 1, France.
Neurochirurgie. 2009 Jun;55(3):340-4. doi: 10.1016/j.neuchi.2008.10.014. Epub 2009 Apr 8.
Spontaneous cerebrospinal fluid fistulas (CSFFs) of the anterior skull base are extremely rare. We report a case of spontaneous CSFF of the ethmoid cribriform plate presenting with rhinorrhea and tension pneumocephalus. We discuss the physiopathology, the radiological management, and the treatment of spontaneous CSF fistulas related to the anterior skull base. A 58-year-old woman was admitted to our institution for headaches with clear rhinorrhea persisting over several days. Antecedents were unremarkable. An episode of epistaxis three days before was reported. Clinical examination showed clear rhinorrhea, headaches, and anosmia. The CT scan showed voluminous epidural and subdural pneumocephalus with mass effect on both frontal and temporal lobes. A high-resolution CT scan with bone reconstruction showed a 2-mm bony defect of the cribriform plate. Surgery consisted of epidural frontal anterior skull base repair. Postsurgery follow-up was uneventful. At one year, the patient was asymptomatic apart from the persistence of anosmia. Spontaneous CSF fistulas are uncommon and can be associated with tension pneumocephalus. The physiopathology remains unclear. Their treatment by complete exclusion of the fistula is necessary because of the lethal risk of pneumococcus meningitis.
前颅底自发性脑脊液瘘（CSFF）极为罕见。我们报告一例筛骨筛板自发性CSFF病例，表现为鼻漏和张力性气颅。我们讨论了与前颅底相关的自发性脑脊液瘘的生理病理学、放射学处理及治疗方法。一名58岁女性因头痛伴清亮鼻漏持续数天入住我院。既往史无特殊。据报告三天前有一次鼻出血。临床检查发现清亮鼻漏、头痛及嗅觉丧失。CT扫描显示大量硬膜外和硬膜下积气，对额叶和颞叶有占位效应。高分辨率CT扫描及骨重建显示筛板有2毫米骨质缺损。手术包括硬膜外额部前颅底修复。术后随访顺利。一年时，除嗅觉丧失持续存在外，患者无症状。自发性脑脊液瘘并不常见，可伴有张力性气颅。其生理病理学仍不清楚。由于存在肺炎球菌脑膜炎的致命风险，通过完全封闭瘘口进行治疗是必要的。
