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鼻中隔瓣治疗伴自发性脑脊液鼻漏的垂体腺瘤：两例报告

Treatment of pituitary adenoma with spontaneous cerebrospinal rhinorrhea using nasoseptal flap, two case reports.

作者信息

Kang Beom Mo, Oh Hyuk-Jin, Ryu Kwang-Hui, Ahn Jae-Min

机构信息

Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.

Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.

出版信息

Surg Neurol Int. 2022 Jun 23;13:262. doi: 10.25259/SNI_61_2022. eCollection 2022.

DOI:10.25259/SNI_61_2022
PMID:35855160
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9282767/
Abstract

BACKGROUND

Postoperative cerebrospinal fluid (CSF) leakages are well documented, but pituitary adenoma with spontaneous CSF rhinorrhea as the initial symptoms are extremely rare. The objective of this study is to report two rare cases of pituitary adenoma with spontaneous CSF rhinorrhea successfully operated by endoscopic transsphenoidal approach with vascularized nasoseptal flap (NSF).

CASE DESCRIPTION

A 70-year-old woman presented with a 6-month history of watery rhinorrhea and posterior nasal drip that worsened when her head leaning forward. Sella magnetic resonance image (MRI) demonstrated pituitary macroadenoma (3.4 × 2.7 cm) invading cavernous sinus, clivus, and sphenoid sinus. A 47-year-old woman presented with a 10-month history of watery rhinorrhea and posterior nasal drip. Sella MRI demonstrated pituitary macroadenoma (6.3 × 4.6 cm) invading cavernous sinus, clivus, sphenoid sinus, and middle fossa. Both patients underwent endoscopic endonasal transsphenoidal operation and skull base reconstruction with vascularized NSF. The postoperative clinical course was uneventful and CSF rhinorrhea disappeared completely.

CONCLUSION

Pituitary adenoma should be suspected if there is a watery CSF rhinorrhea that occurs without a history of trauma or nasal disease. In addition, effective treatment can be performed using NSF, a technique for endoscopic skull base reconstruction.

摘要

背景

术后脑脊液漏已有充分记载，但以自发性脑脊液鼻漏为首发症状的垂体腺瘤极为罕见。本研究的目的是报告两例罕见的以自发性脑脊液鼻漏为表现的垂体腺瘤，通过带血管蒂鼻中隔瓣（NSF）的内镜经蝶窦入路成功进行了手术。

病例描述

一名70岁女性，有6个月的水样鼻漏和后鼻滴漏病史，头部前倾时症状加重。蝶鞍磁共振成像（MRI）显示垂体大腺瘤（3.4×2.7 cm）侵犯海绵窦、斜坡和蝶窦。一名47岁女性，有10个月的水样鼻漏和后鼻滴漏病史。蝶鞍MRI显示垂体大腺瘤（6.3×4.6 cm）侵犯海绵窦、斜坡、蝶窦和中颅窝。两名患者均接受了内镜鼻内蝶窦手术及带血管蒂NSF的颅底重建。术后临床过程顺利，脑脊液鼻漏完全消失。

结论

如果有无创伤或鼻部疾病史的情况下出现水样脑脊液鼻漏，应怀疑垂体腺瘤。此外，使用NSF（一种内镜颅底重建技术）可以进行有效的治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/b44f2359a647/SNI-13-262-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/bc3fdb3737cb/SNI-13-262-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/f3857a33bd2d/SNI-13-262-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/c60a86441ae1/SNI-13-262-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/b44f2359a647/SNI-13-262-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/bc3fdb3737cb/SNI-13-262-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/f3857a33bd2d/SNI-13-262-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/c60a86441ae1/SNI-13-262-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8a7/9282767/b44f2359a647/SNI-13-262-g004.jpg

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