Adachi Satoshi, Ueno Hideaki, Magami Shunsuke, Fujita Naohide, Nakajima Shintaro, Ikemura Ryogo, Ueki Yasuhito, Takaki Yuki, Murofushi Keisuke, Nakao Yasuaki, Yamamoto Takuji
Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
Department of Neurosurgery, Juntendo University Urayasu Hospital, Urayasu, Japan.
Surg Neurol Int. 2023 Jun 30;14:228. doi: 10.25259/SNI_260_2023. eCollection 2023.
Cerebrospinal fluid (CSF) rhinorrhea with meningoencephalocele (MEC) associated with Sternberg's canal is rare. We treated two such cases.
A 41-year-old man and a 35-year-old woman presented with CSF rhinorrhea and mild headache worsening with standing posture. Head computed tomography showed a defect close to the foramen rotundum in the lateral wall of the left sphenoid sinus in both cases. Head magnetic resonance (MR) imaging and MR cisternography revealed that brain parenchyma had herniated into the lateral sphenoid sinus through the defect of the middle cranial fossa. The intradural and extradural spaces and bone defect were sealed with fascia and fat through both intradural and extradural approaches. The MEC was cut away to prevent infection. CSF rhinorrhea completely stopped after the surgery.
Our cases were characterized by empty sella, thinning of the dorsum sellae, and large arteriovenous malformations that suggest chronic intracranial hypertension. The possibility of Sternberg's canal in patients with CSF rhinorrhea with chronic intracranial hypertension should be considered. The cranial approach has the advantages of lower infection risk and the ability to close the defect with multilayer plasty under direct vision. The transcranial approach is still safe if performed by a skillful neurosurgeon.
伴有脑膜脑膨出（MEC）的脑脊液鼻漏与施特恩贝格管相关的情况罕见。我们治疗了两例此类病例。
一名41岁男性和一名35岁女性表现为脑脊液鼻漏和轻度头痛，站立姿势时加重。头部计算机断层扫描显示，两例患者左侧蝶窦外侧壁靠近圆孔处均有缺损。头部磁共振成像（MR）和磁共振脑池造影显示，脑实质通过中颅窝缺损疝入蝶窦外侧。通过硬膜内和硬膜外入路，用筋膜和脂肪封闭硬膜内、外间隙及骨缺损。切除脑膜脑膨出来预防感染。术后脑脊液鼻漏完全停止。
我们的病例具有空蝶鞍、蝶鞍背变薄和大型动静脉畸形的特征，提示存在慢性颅内高压。对于伴有慢性颅内高压的脑脊液鼻漏患者，应考虑施特恩贝格管的可能性。颅部入路具有感染风险较低以及能够在直视下用多层修补术封闭缺损的优点。如果由技术熟练的神经外科医生进行经颅入路手术，仍然是安全的。
