Tandem cranial and spinal cerebrospinal fluid leaks presenting with otogenic tension pneumocephalus: illustrative case.

Autor:	Chau D; 1Division of Neurosurgery, House Institute, Los Angeles, California., Barnard ZR; 1Division of Neurosurgery, House Institute, Los Angeles, California., Muelleman TJ; 2Division of Neuro-otology, House Institute, Los Angeles, California., Olszewski AM; 1Division of Neurosurgery, House Institute, Los Angeles, California., D'Agostino AK; 1Division of Neurosurgery, House Institute, Los Angeles, California., Maya MM; 4Imaging, Cedars-Sinai Hospital and Medical Center, Los Angeles, California., Nisson PL; Departments of3Neurosurgery, and., Peng KA; 2Division of Neuro-otology, House Institute, Los Angeles, California., Schievink WI; Departments of3Neurosurgery, and., Lekovic GP; 1Division of Neurosurgery, House Institute, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2023 Sep 11; Vol. 6 (11). Date of Electronic Publication: 2023 Sep 11 (Print Publication: 2023).
DOI:	10.3171/CASE23300
Abstrakt:	Background: Cranial and spinal cerebrospinal fluid (CSF) leaks are associated with opposite CSF fluid dynamics. The differing pathophysiology between spontaneous cranial and spinal CSF leaks are, therefore, mutually exclusive in theory. Observations: A 66-year-old female presented with tension pneumocephalus. The patient underwent computed tomography (CT) scanning, which demonstrated left-sided tension pneumocephalus, with an expanding volume of air directly above a bony defect of the tegmen tympani and mastoideum. The patient underwent a left middle fossa craniotomy for repair of the tegmen CSF leak. In the week after discharge, she developed a recurrence of positional headaches and underwent head CT. Further magnetic resonance imaging of the brain and thoracic spine showed bilateral subdural hematomas and multiple meningeal diverticula. Lessons: Cranial CSF leaks are caused by intracranial hypertension and are not associated with subdural hematomas. Clinicians should maintain a high index of suspicion for intracranial hypotension due to spinal CSF leak whenever "otogenic" pneumocephalus is found. Close postoperative follow-up and clinical monitoring for symptoms of intracranial hypotension in any patients who undergo repair of a tegmen defect for otogenic pneumocephalus is recommended.
Databáze:	MEDLINE
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