Yoshimura Masaki, Matsusaka Yasuhiro, Terada Aiko, Ishiguro Tomoya, Nakajima Hideki, Yamanaka Kazuhiro, Iwai Yasuhiro, Komiyama Masaki, Sakamoto Hiroaki
Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan.
No Shinkei Geka. 2012 Oct;40(10):897-902.
Spontaneous cerebrospinal fluid rhinorrhea associated with aqueductal stenosis is rare. CSF diversion is reported to be a failure in the majority of cases. The combination of the repair of the skull base and CSF diversion is reported to be successful. We describe a case successfully treated by intradural repair with ventricular drainage followed by endoscopic third ventriculostomy.
A 28-year-old woman presented with rhinorrhea, and occasional attacks of headache, vomiting, and unconsciousness for two years. She had been diagnosed as arrested hydrocephalus for 10 years. Magnetic resonance imaging revealed triventriculomegaly with ballooning of the floor of the third ventricle, tonsilar herniation, right anterior horn herniation into the cribriform plate, and bilateral temporal lobe herniation into the temporal base.
A ventricular drain was inserted followed by dissection of the herniated brain and repair of the enlarged cribriform foramen with periosteal flap. Make sure that the bacterial culture negative, endoscopic third ventriculostomy has been performed. There is no recurrence of hydrocephalus and rhinorrhea for two years.
Direct communication between the lateral ventricle and the nasal/paranasal sinus is a rare complication of aqueductal stenosis and LOVA. Surgical repair of the skull base followed by cerebrospinal fluid diversion with endoscopic third ventriculostomy was a safe and reliable method.
与导水管狭窄相关的自发性脑脊液鼻漏罕见。据报道，脑脊液分流在大多数病例中失败。据报道，颅底修复与脑脊液分流相结合是成功的。我们描述了一例通过硬膜内修复加脑室引流，随后进行内镜下第三脑室造瘘术成功治疗的病例。
一名28岁女性出现鼻漏，伴有偶尔发作的头痛、呕吐和意识丧失，持续两年。她被诊断为脑积水停滞10年。磁共振成像显示三脑室扩大，第三脑室底部呈气球样膨出，扁桃体疝，右前角疝入筛板，双侧颞叶疝入颞底部。
插入脑室引流管，随后分离疝出的脑组织，并用骨膜瓣修复扩大的筛孔。确保细菌培养阴性后，进行了内镜下第三脑室造瘘术。两年内脑积水和鼻漏均未复发。
侧脑室与鼻/鼻窦之间的直接相通是导水管狭窄和低位枕大孔区异常的罕见并发症。颅底手术修复后行内镜下第三脑室造瘘术进行脑脊液分流是一种安全可靠的方法。
