Pross Seth E, Sharon Jeffrey D, Lim Michael, Moghekar Abhay, Rao Aruna, Carey John P
Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine.
Otolaryngology Head and Neck Surgery, University of California San Francisco.
Cureus. 2017 May 19;9(5):e1261. doi: 10.7759/cureus.1261.
While infrequent, cerebrospinal fluid (CSF) leaks are known to occur after surgical resection of vestibular schwannomas. Early signs of CSF leak often include headache and altered mental status. If untreated, life-threatening complications can occur, including brainstem herniation and meningitis. The appropriate surgical treatment for a CSF leak requires accurate localization of the source. While the most likely location of a CSF leak after lateral skull base surgery is through the aerated portions of the temporal bone, we present a unique case of a man with a prolonged CSF leak after an acoustic tumor removal who was ultimately found to have an occult spinal perineural (Tarlov) cyst as the source. Accurate localization was ultimately achieved with CT myelogram after empirically obliterating his mastoid failed to restore intracranial CSF volume. Tarlov cysts are the most common cause of idiopathic intracranial hypotension, and this case highlights the importance of considering this entity in the differential diagnosis of postoperative CSF leaks.
虽然罕见，但已知前庭神经鞘瘤手术切除后会发生脑脊液（CSF）漏。脑脊液漏的早期迹象通常包括头痛和精神状态改变。如果不治疗，可能会出现危及生命的并发症，包括脑干疝和脑膜炎。脑脊液漏的适当手术治疗需要准确确定漏源位置。虽然侧颅底手术后脑脊液漏最可能的位置是通过颞骨的气腔部分，但我们报告了一例独特病例，一名男子在切除听神经瘤后出现长时间脑脊液漏，最终发现其隐匿性脊髓神经周（塔尔洛夫）囊肿是漏源。在经验性封闭其乳突未能恢复颅内脑脊液容量后，最终通过CT脊髓造影实现了准确的定位。塔尔洛夫囊肿是特发性颅内低压最常见的原因，该病例突出了在术后脑脊液漏的鉴别诊断中考虑这一实体的重要性。
