Exploratory operation in a patient with spontaneous temporal bone cerebrospinal fluid leaks:A case report  

作　　者：Yuan-Song He Yong Zheng 

机构地区：[1]The First Clinical Medical College,Guangdong Medical University,Zhanjiang 524000,Guangdong Province,China [2]Department of Neurosurgery,The People’s Hospital of Bao’an Shenzheng,Shenzhen 518000,Guangdong Province,China

出　　处：《World Journal of Clinical Cases》2025年第20期42-48,共7页世界临床病例杂志(英文)

摘　　要：BACKGROUND Cerebrospinal fluid(CSF)leaks in the temporal bone arise from osteodural defects,resulting in an abnormal connection between the subarachnoid space and the adjacent tympanomastoid cavity,which often manifests as otorrhea.Patients typically exhibit symptoms such as headache,unilateral hearing impairment,aural fullness,or even meningitis.Imaging studies are critical for identifying and differentiating the location and characteristics of CSF leaks.However,when the leak's origin remains ambiguous,diagnostic surgery may be warranted to both confirm the diagnosis and facilitate treatment.This report discusses an uncommon case while reviewing relevant literature,focusing on the surgical diagnostic intervention in a 58-year-old male with spontaneous temporal bone CSF leaks.CASE SUMMARY The patient,a 58-year-old man,was admitted for evaluation of left ear fullness,hearing loss,and nasal discharge.Notably,when supine,clear fluid drained from the left nasal cavity,with improvement noted upon sitting.A nasal examination did not reveal significant findings,while the otologic evaluation indicated an intact periosteum;however,considerable fluid accumulation was identified within the left middle ear.Despite undergoing multiple periosteal punctures and conservative medical management,the middle ear effusion persisted.Imaging studies,including magnetic resonance imaging(MRI)and computed tomography,confirmed the presence of left-sided CSF otorrhea,and the head MRI indicated potential CSF rhinorrhea.This raised challenges in determining whether the CSF leak originated from the sphenoid sinus or the temporal bone.Given that CSF otorrhea may drain through the external auditory canal and CSF rhinorrhea from the sellar region can present as nasal leakage,differentiation proved complex.In this case,with an intact external auditory canal,CSF from the middle ear was observed to flow into the nasal cavity via the Eustachian tube.Therefore,leakage from both sites could be misconstrued as CSF rhinorrhea,complicating the diagnostic

关 键 词：Spontaneous temporal bone cerebrospinal fluid leaks Diagnosis Exploratory operation ENDOSCOPIC Case report 

分 类 号：R764[医药卫生—耳鼻咽喉科]