自发性鼻溢液：泡状脊索瘤一种可能隐匿的初始症状。病例说明。
Spontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case.
作者信息
Castello Ruiz Maria Jose, Alsavaf Mohammad Bilal, Fadel Michael, Salem Eman H, Mongkolkul Kittichai, Naksen Pakjira, Godil Saniya S, Otto Bradley A, Carrau Ricardo L, Prevedello Daniel M
机构信息
1Department of Neurosurgery, Hospital Universitario Torrecardenas, Almería, Spain.
2Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio.
出版信息
J Neurosurg Case Lessons. 2023 Mar 27;5(13). doi: 10.3171/CASE236.
BACKGROUND
Spontaneous rhinorrhea may be the initial manifestation of ecchordosis physaliphora (EP). There are currently 47 published cases of symptomatic EP, with spontaneous rhinorrhea being one of the most prevalent symptoms. The authors report 1 case as a cause of cerebrospinal fluid (CSF) fistula.
OBSERVATIONS
A 46-year-old woman presented to the authors' clinic with meningitis secondary to nasal CSF leakage. The computed tomography (CT) scan indicated an imperceptibly thin/dehiscent focus along the posterior wall of the sphenoid air cell's midline. A tumor was identified during endoscopic endonasal CSF repair surgery. EP was diagnosed in the frozen and final pathology.
LESSONS
EP should be considered as a potential cause of spontaneous rhinorrhea. This initial clinical manifestation accounts for 35% of symptomatic EP cases. The prepontine and posterior sphenoid sinus wall appear to be the locations with the highest susceptibility. Surgical therapy of the fistula without excision of the lesion may result in insufficient issue resolution and recurrence.
背景
自发性鼻漏可能是泡状脊索瘤（EP）的初始表现。目前已发表47例有症状的EP病例，自发性鼻漏是最常见的症状之一。作者报告1例作为脑脊液（CSF）瘘的病因。
观察结果
一名46岁女性因鼻脑脊液漏继发脑膜炎就诊于作者所在诊所。计算机断层扫描（CT）显示蝶窦气房后壁中线处有一个难以察觉的薄/裂开病灶。在内镜下经鼻脑脊液修复手术中发现一个肿瘤。在冰冻切片和最终病理检查中诊断为EP。
经验教训
EP应被视为自发性鼻漏的潜在病因。这种初始临床表现占EP有症状病例的35%。脑桥前和蝶窦后壁似乎是最易受累的部位。不切除病变的瘘管手术治疗可能导致问题解决不充分和复发。
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