Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.
Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.
Laryngoscope. 2021 Mar;131(3):462-466. doi: 10.1002/lary.28757. Epub 2020 May 25.
OBJECTIVES/HYPOTHESIS: Spontaneous cerebrospinal fluid (CSF) leaks of the skull base are associated with obesity, multiparity, and elevated intracranial pressure. Although spontaneous CSF leaks often present with rhinorrhea, they can be an underdiagnosed cause of chronic aspiration pneumonitis, a complication that has not been previously reported in detail.
Retrospective case series.
The authors retrospectively reviewed all patients undergoing surgical repair of CSF fistulae at the University of Southern California between 2011 and 2018 to identify those presenting with pulmonary symptoms including dyspnea, aspiration, chronic cough, and shortness of breath caused by chronic noniatrogenic CSF pneumonitis.
Symptomatic chronic pneumonitis was evident in six of 20 patients with spontaneous CSF rhinorrhea. Five women (mean body mass index = 36) had CSF leaks arising from the fovea ethmoidalis (n = 4) and lateral sphenoid region (n = 1). One man had a middle fossa floor dehiscence draining through the eustachian tube. All patients had bilateral ground-glass opacities in their lungs on computed tomography imaging that were attributed to spontaneous CSF fistulae arising from noniatrogenic skull base defects, and one patient underwent a biopsy of a lung lesion at another hospital showing chronic bronchiolitis and adjacent peribronchiolar metaplasia. Five patients underwent endoscopic endonasal repair using an autologous fascial graft and pedicled nasoseptal flap, and one underwent craniotomy for repair. All patients underwent successful repair with no complications or evidence of recurrence. Upon repair of the spontaneous CSF leaks, both pneumonitis symptoms and ground-glass opacities on imaging resolved in all six cases.
Skull base CSF fistulae should be considered as a reversible cause of chronic pneumonitis that is not alleviated or worsens with standard treatment.
4 Laryngoscope, 131:462-466, 2021.
目的/假设：颅底自发性脑脊液（CSF）漏与肥胖、多产和颅内压升高有关。虽然自发性 CSF 漏通常表现为鼻漏，但它们可能是慢性吸入性肺炎的一个被低估的原因，而这种并发症以前并未详细报道过。
回顾性病例系列。
作者回顾性分析了 2011 年至 2018 年期间在美国南加州大学接受 CSF 瘘管手术修复的所有患者，以确定出现因慢性非医源性 CSF 性肺炎引起的呼吸困难、吸入、慢性咳嗽和呼吸急促等肺部症状的患者。
20 例自发性 CSF 鼻漏患者中有 6 例出现有症状的慢性肺炎。5 名女性（平均体重指数=36），CSF 漏来自筛骨窝（n=4）和蝶骨外侧区（n=1）。1 名男性患有中颅窝底缺损通过咽鼓管引流。所有患者的肺部 CT 成像均显示双侧磨玻璃样混浊，这些混浊归因于非医源性颅底缺损引起的自发性 CSF 瘘，其中 1 例患者在另一家医院行肺部病变活检，显示慢性细支气管炎和相邻细支气管周围化生。5 例患者采用自体筋膜移植物和带蒂鼻中隔瓣的内镜经鼻修复，1 例患者行开颅手术修复。所有患者均成功修复，无并发症或复发迹象。在修复自发性 CSF 漏后，6 例患者的肺炎症状和影像学上的磨玻璃样混浊均得到缓解。
颅底 CSF 瘘应被视为慢性肺炎的一个可逆原因，而这种肺炎在标准治疗下不会减轻或加重。
4 级喉镜，131：462-466，2021。
