Ohara Keiichiro, Terao Tohru, Michishita Shotaro, Sato Kunitomo, Sasaki Yuichi, Murayama Yuichi
Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan.
Department of Neurosurgery, Jikei University School of Medicine, Nishi-Shimbashi, Tokyo, Japan.
Surg Neurol Int. 2020 Aug 15;11:245. doi: 10.25259/SNI_268_2020. eCollection 2020.
Cerebrospinal fluid (CSF) leaks and pneumocephalus commonly occur due to head trauma or surgical procedures. Spontaneous CSF (sCSF) leaks, however, occur without any clear etiology and are relatively uncommon.
An 84-year-old woman presented with the right-sided otorrhea. The patient had a history of a ventriculoperitoneal shunt placement following a subarachnoid hemorrhage treated by clip ligation of a left-sided ruptured cerebral aneurysm 7 years before presentation, with shunt catheter ligation after evidence of intraventricular pneumocephalus 6 years before presentation. At admission, computed tomography (CT) imaging of the head showed enlargement of the lateral ventricles, a right mastoid fluid collection, and a defect of the superior wall of the right petrous bone. We performed a right temporal craniotomy for the repair of the CSF leak. Intraoperatively, it was noted that temporal lobe parenchyma herniated into the mastoid air cells through lacerated dura and a partially defective tegmen mastoideum. The leak point was successfully obliterated with a pericranial graft and reinforced by a collagen sheet and fibrin glue. There was no recurrence of otorrhea postoperatively.
This report presents a very unique case of a patient with a CSF leak and pneumocephalus occurring on the contralateral side of a previous cranial surgery. We accurately identified the defect site with CT imaging and repaired the CSF leak by temporal craniotomy. Awareness of the mechanisms by which sCSF leaks can be caused by aberrant arachnoid granulations is imperative for neurosurgeons.
脑脊液（CSF）漏和气颅常见于头部外伤或外科手术。然而，自发性脑脊液（sCSF）漏无明确病因且相对少见。
一名84岁女性因右侧耳漏就诊。患者有脑室腹腔分流术史，7年前在左侧破裂脑动脉瘤夹闭治疗蛛网膜下腔出血后行分流术，6年前在发现脑室内气颅后结扎分流导管。入院时，头部计算机断层扫描（CT）显示侧脑室扩大、右侧乳突积液以及右侧岩骨上壁缺损。我们进行了右侧颞骨开颅术以修复脑脊液漏。术中发现颞叶实质通过撕裂的硬脑膜和部分缺损的乳突盖疝入乳突气房。漏口用帽状腱膜移植物成功封闭，并用胶原膜和纤维蛋白胶加固。术后耳漏未复发。
本报告介绍了一例非常独特的病例，患者在既往颅脑手术对侧发生脑脊液漏和气颅。我们通过CT成像准确识别了缺损部位，并通过颞骨开颅术修复了脑脊液漏。神经外科医生必须了解异常蛛网膜颗粒导致sCSF漏的机制。
