Pluta R M, Ram Z, Patronas N J, Keiser H
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
J Neurosurg. 1994 Jun;80(6):1091-4. doi: 10.3171/jns.1994.80.6.1091.
A 42-year-old woman presented with otorrhea 22 years after extracranial resection of a norepinephrine-secreting glomus jugulare tumor with intravascular embolization and radiation therapy to the intracranial portion of the tumor. Tumor growth was arrested and was associated with a decrease in blood and urine norepinephrine levels. Extensive evaluation of the otorrhea, including computerized tomography-cisternography, gadolinium-enhanced magnetic resonance imaging, and arteriography showed marked diffuse necrosis of the temporal bone and skull base with limited tumor vascularity. Cerebrospinal fluid (CSF) collected from the right ear showed norepinephrine levels of 2975 pg/ml; plasma norepinephrine levels were normal. The precise site of CSF leakage could not be delineated. Exploration of the posterior fossa revealed a large dural defect at the anteromedial aspect of the petrous bone through which CSF flowed over the surface of the residual extradural glomus tumor. The defect was successfully sealed with a fascial patch. Postoperatively, CSF norepinephrine levels were normal and no further leakage was observed.
一名42岁女性，在接受去甲肾上腺素分泌性颈静脉球瘤颅外切除并对肿瘤颅内部分进行血管内栓塞和放射治疗22年后出现耳漏。肿瘤生长得到抑制，且血、尿去甲肾上腺素水平下降。对耳漏进行的广泛评估，包括计算机断层扫描脑池造影、钆增强磁共振成像和动脉造影，显示颞骨和颅底有明显的弥漫性坏死，肿瘤血管有限。从右耳收集的脑脊液显示去甲肾上腺素水平为2975 pg/ml；血浆去甲肾上腺素水平正常。脑脊液漏的精确部位无法确定。后颅窝探查发现岩骨前内侧有一个大的硬脑膜缺损，脑脊液通过该缺损流到残留的硬膜外颈静脉球瘤表面。该缺损用筋膜补片成功封闭。术后，脑脊液去甲肾上腺素水平正常，未再观察到漏液。
