Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA.
Department of Obstetrics and Gynecology, University of California Irvine Medical Center, 3800 West Chapman Ave, Ste 3800, Orange, CA, USA.
BMC Pregnancy Childbirth. 2023 Mar 8;23(1):154. doi: 10.1186/s12884-023-05460-5.
Idiopathic intracranial hypertension can lead to dural defects and spontaneous leakage of cerebrospinal fluid (CSF) from the skull base. Skull base CSF leaks are rarely reported in pregnancy but pose unique challenges for obstetricians and anesthesiologists.
A 31-year-old G4P1021 at 14 weeks developed debilitating headaches and CSF rhinorrhea. Brain imaging revealed a bony defect of the sphenoid sinus with a meningoencephalocele and a partially empty sella, consistent with CSF leakage from a skull base defect. The patient was neurologically stable without signs of meningitis; thus, management was focused on symptomatic alleviation. A planned cesarean section was performed at 38 weeks under spinal anesthesia. The patient had spontaneous marked improvement of her symptoms postpartum.
Pregnancy may exacerbate skull base CSF leaks, requiring careful management with a multidisciplinary team. Neuraxial anesthesia can safely be performed in pregnant individuals with spontaneous skull base CSF leakage, but further studies are needed to determine the safest mode of delivery in these patients.
特发性颅内高压可导致硬脑膜缺损，并使颅底的脑脊液（CSF）自发性渗漏。在妊娠期间，颅底 CSF 漏极为罕见，但给产科医生和麻醉师带来了独特的挑战。
一位 31 岁的 G4P1021 孕妇在妊娠 14 周时出现严重头痛和 CSF 鼻漏。脑部影像学显示蝶窦骨质缺损，伴有脑膜脑膨出和部分空蝶鞍，提示颅底缺损导致 CSF 漏。患者神经功能稳定，无脑膜炎迹象，因此治疗重点是缓解症状。在 38 周时，患者接受了脊髓麻醉下的计划性剖宫产。产后患者的症状自发显著改善。
妊娠可能使颅底 CSF 漏加重，需要多学科团队进行仔细管理。对于自发性颅底 CSF 漏的孕妇，可以安全地进行神经轴麻醉，但需要进一步研究以确定这些患者的最佳分娩方式。
