Empty sellalı bir olguda spontan serebrospinal rinore: Fistülün transnazal transsfenoidal onarımı
Spontan serebrospinal rinore nadir görülen bir du- rumdur; daha sıklıkla serabral tümörlere veya hid- rosefalusa bağlı olarak geliflir. Empty sella sendro- mu ile birlikte görülmesi daha da nadirdir. Sol na- zal akıntı flikayetiyle baflvuran 63 yaflındaki kadın hasta, serebrospinal sıvı rinoresi öntanısı ile yatı- rıldı. Nazal sıvı incelendiğinde renksiz olduğu gö- rüldü; Pandy testi pozitif, glukoz %72 düzeyinde bulundu. Manyetik rezonans görüntülemede sup- rasellar sisternanın sellar kaviteye herniye olduğu ve sfenoid sinüsün orta derecede kontrast tuttuğu izlendi. Fistülün onarımı transnazal ve transsfeno- idal yolla gerçeklefltirildi. Hastanın befl yıllık takibi süresince herhangi bir semptom ya da nüksle kar- fl ı l a fl ı l m a d ı
Anahtar Kelimeler:
Beyin omurilik sıvısı rinoresi/komplikasyon/cerrahi, fistül/komplikasyon/cerrahi, manyetik rezonans görüntüleme, sella turcica, sfenoid sinüs/cerrahi, subaraknoid boflluk
Spontaneous cerebrospinal fluid rhinorrhea associated with empty sella: a transnasal-transsphenoidal repair of the fistula
Spontaneous cerebrospinal rhinorrhea is a rare clinical condition. More commonly it develops due to cerebral tumours or hydrocephalus; it is seldom seen in association with empty sella syndrome. A sixty-three-year- old woman who presented with left nasal discharge was hospitalized on the suspicion of CSF rhinorrhea.Analysis of the nasal fluid revealed a clear colour, a positive Pandy’s test, and a positive result for glucose 72% . On magnetic resonance seans, herniation of the suprasellar cistern was observed into the sellar cavity, and the left sphenoid sinüs was filled with contrast medium. The repair of the fistula was performed via a transnasal and transsphenoidal approach. The patient was followed-up for five years without any symptoms or recurrences.
Keywords:
Cerebrospinal fluid rhinorrhea/complications/ surgery, fistula/complications/surgery, magnetic resonance imaging, sellaturcica, sphenoid sinus/surgery, subarachnoid space,
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- B rockbank MJ, Veitch DY, Thomson HG. Cere b ro s p i n a l fluid in the rhinitis clinic. J Laryngol Otol 1989;103:281-3.
- Tolley NS, Lloyd GA, Williams HO. Radiological study of primary spontaneous CSF rhinorrhoea. J Laryngol Otol 1991;105:274-7.
- Garcia-Uria J, Carrillo R, Serrano P, Bravo G. Empty sella and rhinorrhea. A report of eight treated cases. J Neurosurg 1979;50:466-71.
- Weiss MH, Kaufman B, Richards DE. Cerebrospinal fluid rhinorrhea from an empty sella: transsphenoidal obliteration of the fistula. Technical note. J Neurosurg 1973;39:674-6.
- Bleach NR, Stanworth PA, Stansbie JM. Spontaneous cerebrospinal fluid rhinorrhoea (an investigative prob- lem). J Laryngol Otol 1988;102:633-5.
- Ommaya AK. Spinal fluid fistulae. Clin Neurosurg 1976;23:363-92.
- Loew F, Pertuiset B, Chaumier ET. Traumatic, sponta- neous and postoperative CSF rhinorrhea. In: Symon L, Brihaye J, editors. Advances and technical standarts in neurosurgery. 1st ed. New York: Springer; 1984. p. 169- 207.
- Calcaterra TC. Extracranial surgical repair of cere- b rospinal rh i n o r rhea. Ann Otol Rhinol Laryngol 1980; 89(2 Pt 1):108-16.
- Jordan RM, Kendall JW, Kerber CW. The primary empty sella syndrome: analysis of the clinical charac- teristics, radiographic features, pituitary function and cerebrospinal fluid adenohypophysial hormone con- centrations. Am J Med 1977;62:569-80.
- Mortara R, Norrell H. Consequences of a deficient sel- lar diaphragm. J Neurosurg 1970;32:565-73.
- Briant TD, Bird R. Extracranial repair of cerebrospinal fluid fistulae. J Otolaryngol 1982;11:191-7.
- Park JI, Strelzow VV, Friedman WH. Current manage- ment of cerebrospinal fluid rhinorrhea. Laryngoscope 1983;93:1294-300.
- Chandler JR. Traumatic cerebrospinal fluid leakage. Otolaryngol Clin North Am 1983;16:623-32.
- Persky MS, Rothstein SG, Breda SD, Cohen NL, Cooper P, Ransohoff J. Extracranial repair of cere b rospinal fluid o t o rh i n o r rhea. Laryngoscope 1991;101:134-6.
- Marshall AH, Jones NS, Robertson IJ. CSF rhinorrhoea: the place of endoscopic sinus surgery. Br J Neurosurg 2001;15:8-12.
- Daniilidis J, Vlachtsis K, Ferekidis E, Dimitriadis A. Intrasphenoidal encephalocele and spontaneous CSF rhinorrhoea. Rhinology 1999;37:186-9.
- ISSN: 2602-4837
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1991
- Yayıncı: İstanbul Üniversitesi