Pôle tête et cou, clinique universitaire ORL, CHU de Grenoble, 1, avenue des Maquis-du-Grésivaudan, Grenoble cedex 09, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Dec;130(6):341-3. doi: 10.1016/j.anorl.2012.09.013. Epub 2013 May 28.
To raise awareness of the possibility of spontaneous temporal bone cerebrospinal fistula in case of clear retrotympanic effusion.
A 63-year-old man with no particular history presented with unilateral spontaneous right retrotympanic clear effusion. CT found defects in the posterior part of the right temporal bone, in contact with arachnoid granulations, with no other visible abnormalities.
DISCUSSION/CONCLUSION: Unilateral clear retrotympanic effusion in an adult subject should, apart from serous otitis media, suggest possible cerebrospinal fistula. In the absence of otologic or traumatic history, arachnoid granulation is one possible etiology, inducing spontaneous cerebrospinal fluid leakage when facing the temporal bone. Diagnosis is suggested by bone defects in the tegmen tympani or posterior wall of the temporal bone on CT, with the adjacent mastoid cavities filled with fluid. Pneumococcal vaccination and early surgical repair of the fistula should be performed to avoid neuromeningeal infection.
当出现明确的鼓室后积液时，提醒注意自发性颞骨脑脊髓液瘘的可能性。
一名 63 岁男性，无特殊病史，表现为单侧自发性右鼓室后透明积液。CT 发现右颞骨后部有缺陷，与蛛网膜颗粒接触，无其他可见异常。
讨论/结论：除浆液性中耳炎外，成人单侧透明鼓室后积液除提示可能存在脑脊髓液瘘外。在没有耳科或外伤病史的情况下，蛛网膜颗粒是一种可能的病因，当面对颞骨时会导致自发性脑脊液漏。CT 显示鼓室盖或颞骨后壁有骨缺损，相邻乳突腔充满液体，提示诊断。肺炎球菌疫苗接种和早期瘘管手术修复应可避免脑脊膜感染。
