Skull Base 2010; 20(6): 455-458
DOI: 10.1055/s-0030-1261268
CASE REPORT

© Thieme Medical Publishers

Double Skull Base Defects with Primary Spontaneous Cerebrospinal Fluid Leaks in a Single Patient: Temporal and Sphenoid Bones

Benjamin Schmitt1 , Jean-Michel Badet1 , Jean-Claude Chobaut1 , 2 , Laurent Tavernier1 , 2
  • 1Department of ENT and Head and Neck Surgery, University Hospital of Besançon, Besançon cedex, France
  • 2EA4268, I4S, IFR133, University of Franche-Comté, Besançon cedex, France
Further Information

Publication History

Publication Date:
07 July 2010 (online)

ABSTRACT

Primary spontaneous cerebrospinal fluid leaks occurring in the absence of any apparent cause are rare. Patients may present such leaks simultaneously, or successively, in multiple locations. We report here the sixth case of anterior and lateral skull base defects presented in a single patient. Although rhinoliquorrhea and otoliquorrhea were reported separately in the literature, we postulated that the pathophysiology is the same for the whole skull base; obesity seems to contribute to the development of such primary spontaneous cerebrospinal fluid leak. Consequently, management is similar and regular follow-up is very important.

REFERENCES

  • 1 Wolf G, Greistorfer K, Stammberger H. Endoscopic detection of cerebrospinal fluid fistulas with a fluorescence technique. Report of experiences with over 925 cases.  Laryngorhinootologie. 1997;  76(10) 588-594
  • 2 Banks C A, Palmer J N, Chiu A G, O'Malley Jr B W, Woodworth B A, Kennedy D W. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years.  Otolaryngol Head Neck Surg. 2009;  140(6) 826-833
  • 3 Schlosser R J, Bolger W E. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: a clinical association.  Am J Rhinol. 2003;  17(2) 91-96
  • 4 Holzmann D, Wild C. Obesity as a Risk Factor for Primary Spontaneous Rhinoliquorrhea.  Otolaryngol Head Neck Surg. 2003;  129(3) 324-326
  • 5 Prichard C N, Isaacson B, Oghalai J S, Coker N J, Vrabec J T. Adult spontaneous CSF otorrhea: correlation with radiographic empty sella.  Otolaryngol Head Neck Surg. 2006;  134(5) 767-771
  • 6 Scurry Jr W C, Ort S A, Peterson W M, Sheehan J M, Isaacson J E. Idiopathic temporal bone encephaloceles in the obese patient.  Otolaryngol Head Neck Surg. 2007;  136(6) 961-965
  • 7 Rotilio A, Andrioli G C, Scanarini M, Zuccarello M, Fiore D L. Concurrent spontaneous CSF otorrhea and rhinorrhea.  Eur Neurol. 1982;  21(2) 77-83
  • 8 May J S, Mikus J L, Matthews B L, Browne J D. Spontaneous cerebrospinal fluid otorrhea from defects of the temporal bone: a rare entity?.  Am J Otol. 1995;  16(6) 765-771
  • 9 Pappas Jr D G, Pappas Sr D G, Hoffman R A, Harris S D. Spontaneous cerebrospinal fluid leaks originating from multiple skull base defects.  Skull Base Surg. 1996;  6(4) 227-230
  • 10 Raghavan U, Majumdar S, Jones N S. Spontaneous CSF rhinorrhoea from separate defects of the anterior and middle cranial fossa.  J Laryngol Otol. 2002;  116(7) 546-547
  • 11 González-Garcia J A, Garcia-Berrocal J R, Trinidad A, Verdaguer J M, Sanz R, Ramirez-Camacho R. Endonasal endoscopic management of a large meningocephalocele in a patient with concomitant middle skull base defect.  Minim Invasive Neurosurg. 2006;  49(5) 309-311
  • 12 Gacek R R. Arachnoid granulation cerebrospinal fluid otorrhea.  Ann Otol Rhinol Laryngol. 1990;  99(11) 854-862
  • 13 Quiney R E, Mitchell D B, Djazeri B, Evans J N. Recurrent meningitis in children due to inner ear abnormalities.  J Laryngol Otol. 1989;  103(5) 473-480
  • 14 Pappas Jr D G, Hoffman R A, Cohen N L, Pappas Sr D G. Spontaneous temporal bone cerebrospinal fluid leak.  Am J Otol. 1992;  13(6) 534-539
  • 15 Ommaya A K, Di Chiro G, Baldwin M, Pennybacker J B. Non-traumatic cerebrospinal fluid rhinorrhoea.  J Neurol Neurosurg Psychiatry. 1968;  31(3) 214-225
  • 16 Hubbard J L, McDonald T J, Pearson B W, Laws Jr E R. Spontaneous cerebrospinal fluid rhinorrhea: evolving concepts in diagnosis and surgical management based on the Mayo Clinic experience from 1970 through 1981.  Neurosurgery. 1985;  16(3) 314-321
  • 17 Badia L, Loughran S, Lund V. Primary spontaneous cerebrospinal fluid rhinorrhea and obesity.  Am J Rhinol. 2001;  15(2) 117-119
  • 18 Woodworth B A, Prince A, Chiu A G et al.. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension.  Otolaryngol Head Neck Surg. 2008;  138(6) 715-720

Laurent TavernierM.D. 

Department of ENT and Head and Neck Surgery, University Hospital of Besançon, Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Universitaire Jean Minjoz, 3, boulevard Fleming

25030 Besançon cedex, France

Email: ltavernier@chu-besancon.fr

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