Yildirim Ali Erdem, Dursun Engin, Divanlioglu Denizhan, Ozdol Cagatay, Nacar Osman Arıkan, Corapci Ovunc Erdem, Belen Ahmed Deniz
Ankara Numune Research and Education Hospital, Department of Neurosurgery, Ankara, Turkey.
Turk Neurosurg. 2014;24(2):276-80. doi: 10.5137/1019-5149.JTN.7098-12.0.
Delayed posttraumatic cerebrospinal fluid rhinorrhea (CSFr) without meningitis is considered to be relatively rare. However, even years after trauma, recurrence or delayed onset of CSFr and meningitis due to CSFr are possible. In this article, a case of delayed CSFr from the sphenoid sinus without meningitis three years after the transfacial gunshot wound is reported. Plain high-resolution computed tomography sections through the sphenoid sinus showed a bone defect at the roof with CSF-density fluid extending into the sphenoid sinus. Arachnoid membrane herniation into the sphenoid sinus was found and site of CSF fistula confirmed during the surgery. Skull base defect was reconstructed through an endoscopic approach without any complications and the patient was followed up for 12 months without recurrence. The cause, timing, clinical course and location of CSFr make this an apparently unique case. Patients with a skull base defect without CSFr should be closely followed up and may need further evaluation or management due to the possibility of CSFr development. The positive diagnosis of a CSFr raises the matter of choosing the adequate surgical approach for its repair. Endoscopic closure of CSFr is both safe and effective.
创伤后迟发性脑脊液鼻漏（CSFr）且无脑膜炎被认为相对罕见。然而，即使在创伤多年后，CSFr复发或因CSFr导致脑膜炎延迟发作也是有可能的。本文报道了1例经面部枪伤三年后出现来自蝶窦的迟发性CSFr且无脑膜炎的病例。通过蝶窦的普通高分辨率计算机断层扫描显示蝶窦顶部有骨缺损，脑脊液密度的液体延伸至蝶窦。术中发现蛛网膜下腔疝入蝶窦并证实了脑脊液瘘的部位。通过内镜方法重建颅底缺损，无任何并发症，对患者随访12个月无复发。CSFr的病因、时间、临床过程和部位使其成为一个明显独特的病例。无CSFr的颅底缺损患者应密切随访，由于可能发生CSFr，可能需要进一步评估或处理。CSFr的阳性诊断引发了选择合适手术方法进行修复的问题。内镜下封闭CSFr既安全又有效。
