Abstract：
OBJECTIVE: Recurrent cerebrospinal fluid (CSF) rhinorrhea caused by sequential, anatomically separated skull base defects is rarely reported in the literature. Neither management nor etiology has been sufficiently investigated. We present an illustrative case and a systematic review of the literature regarding etiology, diagnostics, and management of this rare phenomenon.
METHODS: A systematic literature search looking for articles reporting sequential CSF leaks with multiple skull base defects was performed. Data from included articles were descriptively reported, and the quality of the included studies was assessed with Grading of Recommendations Assessment, Development and Evaluation.
RESULTS: A 71-year-old woman with posttraumatic CSF rhinorrhea and left-sided CSF otorrhea due to a left-sided horizontal fracture of the petrous bone presented at our institution. After initial surgical repair and a 10-week symptom-free interval, CSF rhinorrhea recurred. Imaging revealed a preexisting contralateral meningoencephalocele of the lateral sphenoid recess causing recurrent CSF rhinorrhea most likely after initial traumatic laceration. The defect was successfully treated. A literature search identified 366 reports, 6 of which were included in the systematic review with a total of 10 cases. Quality was deemed good in 8 of 10 cases. The most common location for primary and sequential CSF leaks was along the sphenoid bone (4/10 and 5/10 patients, respectively). All publications except one reported the presence of a meningo (encephalo)cele as cause of the sequential CSF leak.
CONCLUSIONS: Occurrence of recurrent CSF rhinorrhea due to an anatomically separated sequential skull base lesion remains a rare phenomenon. Reassessment of imaging studies and a structured diagnostic workup to detect sequential CSF leaks independent of the primary lesion should is recommended.
METHODS: A systematic literature search looking for articles reporting sequential CSF leaks with multiple skull base defects was performed. Data from included articles were descriptively reported, and the quality of the included studies was assessed with Grading of Recommendations Assessment, Development and Evaluation.
RESULTS: A 71-year-old woman with posttraumatic CSF rhinorrhea and left-sided CSF otorrhea due to a left-sided horizontal fracture of the petrous bone presented at our institution. After initial surgical repair and a 10-week symptom-free interval, CSF rhinorrhea recurred. Imaging revealed a preexisting contralateral meningoencephalocele of the lateral sphenoid recess causing recurrent CSF rhinorrhea most likely after initial traumatic laceration. The defect was successfully treated. A literature search identified 366 reports, 6 of which were included in the systematic review with a total of 10 cases. Quality was deemed good in 8 of 10 cases. The most common location for primary and sequential CSF leaks was along the sphenoid bone (4/10 and 5/10 patients, respectively). All publications except one reported the presence of a meningo (encephalo)cele as cause of the sequential CSF leak.
CONCLUSIONS: Occurrence of recurrent CSF rhinorrhea due to an anatomically separated sequential skull base lesion remains a rare phenomenon. Reassessment of imaging studies and a structured diagnostic workup to detect sequential CSF leaks independent of the primary lesion should is recommended.
摘要：
目的：由连续的脑脊液（CSF）引起的复发性鼻漏，解剖学上分离的颅底缺损在文献中很少报道。管理和病因均未得到充分调查。我们在此提供一个说明性的案例和有关病因学的文献的系统综述，诊断,和管理这种罕见的现象。
方法：进行了系统的文献检索，寻找报道有多个颅底缺损的连续脑脊液漏的文章。纳入文章的数据是描述性报道的，纳入研究的质量采用GRADE评估.
结果：一位71岁的女性患者，在我们的机构中出现了由于岩骨左侧纵向骨折导致的外伤性鼻漏和左侧耳漏。在初次手术修复和十周无症状间隔后，脑脊液鼻漏复发。影像学检查显示，蝶窦外侧隐窝先前存在的对侧脑膜脑膨出，在最初的创伤性裂伤后很可能导致复发的CSF鼻漏。该缺陷已成功治疗。文献检索确定了366份报告，其中6例纳入系统审查，共10例。在8/10例中，质量被认为是好的。原发性和序贯性CSF渗漏最常见的位置是沿着蝶骨（4/10和5/10患者，分别)。除一篇出版物外，所有出版物都报道了脑膜（脑）细胞的存在是连续CSF泄漏的原因。
结论：由于解剖学上分离的顺序颅底病变引起的复发性CSF鼻漏的发生仍然是一种罕见的尚未描述的现象。因此，应考虑重新评估影像学研究和结构化的诊断工作，以检测与原发性病变无关的连续CSF泄漏。
方法：进行了系统的文献检索，寻找报道有多个颅底缺损的连续脑脊液漏的文章。纳入文章的数据是描述性报道的，纳入研究的质量采用GRADE评估.
结果：一位71岁的女性患者，在我们的机构中出现了由于岩骨左侧纵向骨折导致的外伤性鼻漏和左侧耳漏。在初次手术修复和十周无症状间隔后，脑脊液鼻漏复发。影像学检查显示，蝶窦外侧隐窝先前存在的对侧脑膜脑膨出，在最初的创伤性裂伤后很可能导致复发的CSF鼻漏。该缺陷已成功治疗。文献检索确定了366份报告，其中6例纳入系统审查，共10例。在8/10例中，质量被认为是好的。原发性和序贯性CSF渗漏最常见的位置是沿着蝶骨（4/10和5/10患者，分别)。除一篇出版物外，所有出版物都报道了脑膜（脑）细胞的存在是连续CSF泄漏的原因。
结论：由于解剖学上分离的顺序颅底病变引起的复发性CSF鼻漏的发生仍然是一种罕见的尚未描述的现象。因此，应考虑重新评估影像学研究和结构化的诊断工作，以检测与原发性病变无关的连续CSF泄漏。
