A Case of Cerebrospinal Fluid Rhinorrhea Associated with Meningocele Treated with Endoscopic Endonasal Approach

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  • Kitada Yuji
    Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University
  • Kikuchi Masahiro
    Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University
  • Omori Koichi
    Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University

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  • 鼻内視鏡手術を行った髄膜瘤に伴う髄液鼻漏例

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Abstract

<p>The patient was a 47-year-old female. She had no history of head trauma, but had a history of recurrent cerebrospinal fluid (CSF) rhinorrhea and meningitis for the past 15 years. Left rhinorrhea was persistent and a meningocele was identified on head MRI. Nasal endoscopy revealed a white mass and pulsatile CSF leakage in the left sphenoethmoidal recess. Paranasal sinus CT showed a defect in the cribriform plate medial to the left superior turbinate and protrusion of soft tissue into the nasal cavity. T2-weighted MRI showed a high signal equivalent to that of spinal fluid in the meningocele.</p><p>Because of persistent cerebrospinal rhinorrhea, endoscopic closure of CSF rhinorrhea was performed. A meningocele of approximately 5 mm in size was found at the olfactory cleft medial to the left superior turbinate. The meningocele was cauterized and reduced in size, and the surrounding cribriform plate was removed to expose a 10 × 5-mm dura mater. Artificial dural grafts (DuraGen®) were placed between the dura mater and the bone in an inlay manner, and on the bone wall in an overlay manner. In addition, a middle turbinate mucosal flap was harvested and implanted on the dural graft, and multilayer skull base reconstruction was performed. No recurrence of CSF leakage was observed after the surgery.</p><p>A transnasal endoscopic approach may be a positive indication for closure of CSF rhinorrhea associated with meningocele at the cribriform plate.</p>

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