Gharzouli Imen, Verillaud Benjamin, Tran Hugo, Blancal Jean-Philippe, Sauvaget Elisabeth, Kania Romain, Guichard Jean-Pierre, Herman Philippe
Service d'ORL et Chirurgie Cervicofaciale, Hôpital Lariboisière, AP-HP, Université Paris 7 Diderot, EA REMES, 2 Rue Ambroise Paré, 75010, Paris, France.
Neuroradiology Department, Hôpital Lariboisière, AP-HP, Université Paris Diderot, Paris, France.
Eur Arch Otorhinolaryngol. 2016 Jul;273(7):1643-7. doi: 10.1007/s00405-015-3599-4. Epub 2015 Mar 18.
To report on the presence of olfactory arachnoid dilatations (OAD), a previously undescribed radiologic feature of spontaneous cerebrospinal fluid (CSF) rhinorrhea originating from the cribriform plate of the ethmoid bone. The medical records of all patients treated between 2001 and 2011 at a tertiary care center for a spontaneous CSF rhinorrhea originating from the cribriform plate were retrospectively reviewed. The radiological work-up included high-resolution computed tomography and magnetic resonance imaging with at least the following sequences: T1, T2, and T2 with fast imaging employing steady state acquisition (FIESTA). Thirty cases were identified. The mean age at diagnosis was 49. Fourteen patients (47 %) had a body mass index (BMI) of 30 or more and 3 patients (10 %) had a BMI between 25 and 29.9. Five patients had a history of meningitis. The imaging work-up revealed a bone defect of the cribriform plate in 6 cases (20 %), associated to a typical meningocele in 14 cases (47 %). In ten patients (33 %), there was no defect of the cribriform plate, but ultrathin coronal T2-FIESTA sequences revealed an OAD, i.e. a dilatation of the arachnoid sheath of the olfactory fibers, in nine cases (30 %), or a "pseudo-polyp" outlined by a thin layer of arachnoid (1 patient, 3 %). Preoperative imaging should be carefully analyzed for the presence of OAD or "pseudo-polyp" in patients presenting with a CSF rhinorrhea without bony defect of the cribriform plate.
报告嗅觉蛛网膜扩张（OAD）的存在，这是一种源自筛骨筛板的自发性脑脊液（CSF）鼻漏的先前未描述的放射学特征。对2001年至2011年在一家三级医疗中心接受治疗的所有源自筛板的自发性CSF鼻漏患者的病历进行回顾性研究。影像学检查包括高分辨率计算机断层扫描和磁共振成像，至少有以下序列：T1、T2以及采用稳态采集快速成像（FIESTA）的T2。共识别出30例病例。诊断时的平均年龄为49岁。14名患者（47%）的体重指数（BMI）为30或更高，3名患者（10%）的BMI在25至29.9之间。5名患者有脑膜炎病史。影像学检查显示6例（20%）存在筛板骨缺损，14例（47%）伴有典型的脑膜膨出。10例患者（33%）筛板无缺损，但超薄冠状位T2-FIESTA序列显示9例（30%）存在OAD，即嗅神经纤维蛛网膜鞘扩张，或1例（3%）有一层薄薄的蛛网膜勾勒出的“假息肉”。对于出现CSF鼻漏且筛板无骨缺损的患者，术前影像学检查应仔细分析是否存在OAD或“假息肉”。
