Document Detail


Pseudomeningoceles of the sphenoid sinus masquerading as sinus pathology.
MedLine Citation:
PMID:  22052361     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES/HYPOTHESIS: To describe the clinical presentation, pathophysiology, and treatment of spontaneous cerebrospinal fluid (CSF) leaks of the sphenoid bone, with an emphasis on a previously undescribed form in this location, in which CSF is trapped under the mucosa of the sinonasal cavity or in the soft tissue of the skull base.
STUDY DESIGN: Case series and literature review.
METHODS: Analysis of cases through medical records and literature review.
RESULTS: Four examples of unusual spontaneous CSF leaks of the skull base are presented. In each case, a CSF collection was contained behind the sinonasal mucosa of the sphenoid sinus, resembling a nasal polyp or mucocele on exam or imaging. In one case, the fluid collection was also associated with significant bone resorption and extravasation into the soft tissue of the infratemporal fossa. In each case, small defects of the ventral skull base (sphenoid bone) were the source of the CSF leaks. Successful treatment was achieved after transnasal endoscopic repair of the skull base defects using a combination of free abdominal fat grafts, free fascial grafts, and pedicled nasoseptal flaps. Postoperatively, a ventriculoperitoneal shunt was placed if the intracranial pressure was elevated.
CONCLUSIONS: Spontaneous CSF leaks arising in the sphenoid sinus may not always present with overt CSF rhinorrhea but with a submucosal fluid collection (pseudomeningocele) that may mimic a mucocele or nasal polyp. These bona fide pseudomeningoceles of the skull base may be associated with elevated intracranial pressure and can be managed using endoscopic endonasal surgery.
Authors:
Alec Vaezi; Carl H Snyderman; Hesham A Saleh; Ricardo L Carrau; Adam Zanation; Paul Gardner
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2011-11-02
Journal Detail:
Title:  The Laryngoscope     Volume:  121     ISSN:  1531-4995     ISO Abbreviation:  Laryngoscope     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-23     Completed Date:  2012-01-23     Revised Date:  2014-09-15    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2507-13     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebrospinal Fluid Rhinorrhea / diagnosis*,  surgery
Diagnosis, Differential
Endoscopy / methods*
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging / methods
Male
Meningocele / diagnosis*,  surgery
Middle Aged
Paranasal Sinus Diseases / diagnosis*,  surgery
Postoperative Care / methods
Preoperative Care / methods
Risk Assessment
Skull Base / surgery
Sphenoid Sinus / pathology,  surgery*
Tomography, X-Ray Computed / methods
Treatment Outcome
Grant Support
ID/Acronym/Agency:
T32 CA060397/CA/NCI NIH HHS; T32 CA060397/CA/NCI NIH HHS; T32 CA060397-10/CA/NCI NIH HHS
Comments/Corrections
Comment In:
Am J Rhinol Allergy. 2012 May-Jun;26(3):251   [PMID:  22643957 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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