Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound

YILDIRIM, Ali Erdem; ÖZDÖL, Çağatay; BELEN, Ahmed Deniz; DURSUN, Engin; DIVANLIOGLU, Denizhan; CORAPCI, Ovunc Erdem; NACAR, Osman Arıkan

Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound

Ali Erdem YILDIRIM, (Sağlık Bakanlığı, Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye)

Engin DURSUN, (Recep Tayyip Erdoğan Üniversitesi, Tıp Fakültesi, Rize, Türkiye)

Denizhan DIVANLIOGLU, (Sağlık Bakanlığı, Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye)

Çağatay ÖZDÖL, (SB Antalya Eğitim ve Araştırma Hastanesi, Antalya, Türkiye)

Osman Arıkan NACAR, (Sağlık Bakanlığı, Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye)

Ovunc Erdem CORAPCI, (Sağlık Bakanlığı, Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye)

Ahmed Deniz BELEN (Sağlık Bakanlığı, Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye)

Turkish Neurosurgery

1 0

Yıl: 2014 Cilt: 24 Sayı: 2 Sayfa Aralığı: 276 - 280 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound

Öz:

Menenjit olmaksızın geç dönemde gelişen posttravmatik rinore nadir görülen bir durum olmasına rağmen, travmadan sonra yıllar içindegeç dönem rinore ve buna bağlı menenjit gelişmesi mümkündür. Bu makalede, 3 yıl önce yüz bölgesinde ateşli silah yaralanması meydanageldikten sonra, menenjit olmaksızın geç dönemde ortaya çıkan bir rinore olgusu sunulmaktadır. Hastanın yapılan incelemelerinde sfenoidsinüs tavanında kemik defekti ve bu defektten beyin omurilik sıvısı (BOS) kaçışı olduğu gösterilmiştir. Cerrahi sırasında sinüs içerisinearaknoid membran herniasyonu izlenmiş olup, defektten BOS kaçağı olduğu da görülmüştür. Kafa tabanındaki defekt endoskopik endonazaltranssfenoidal yaklaşım ile hiçbir komplikasyon olmadan tamir edilmiş ve hastanın 12 aylık takiplerinde hiçbir rekürrens izlenmemiştir.Rinorenin nedeni, zamanı, klinik seyri ve lokalizasyonu nedeniyle bu nadir görülen bir olgu olarak kabul edilebilir. Kafa tabanı defekti olan fakatrinore gözlenmeyen hastalar ileride rinore gelişme riski nedeniyle yakın takip edilmelidir. Rinore tanısı kesinleşen hastalarda, cerrahi yaklaşımyolları arasından, endoskopik endonazal yolla yapılan onarım hem efektif hem de güvenli olarak kabul edilmektedir.

Anahtar Kelime:

Konular: Cerrahi

Ateşli Silah Yaralanması Sonrası Geç Dönem Posttravmatik Rinore Olgusu

Öz:

Delayed posttraumatic cerebrospinal fluid rhinorrhea (CSFr) without meningitis is considered to be relatively rare. However, even years aftertrauma, recurrence or delayed onset of CSFr and meningitis due to CSFr are possible. In this article, a case of delayed CSFr from the sphenoidsinus without meningitis three years after the transfacial gunshot wound is reported. Plain high-resolution computed tomography sectionsthrough the sphenoid sinus showed a bone defect at the roof with CSF-density fluid extending into the sphenoid sinus. Arachnoid membraneherniation into the sphenoid sinus was found and site of CSF fistula confirmed during the surgery. Skull base defect was reconstructed throughan endoscopic approach without any complications and the patient was followed up for 12 months without recurrence. The cause, timing,clinical course and location of CSFr make this an apparently unique case. Patients with a skull base defect without CSFr should be closelyfollowed up and may need further evaluation or management due to the possibility of CSFr development. The positive diagnosis of a CSFrraises the matter of choosing the adequate surgical approach for its repair. Endoscopic closure of CSFr is both safe and effective.

Anahtar Kelime:

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık

1. Cappabianca P, Cavallo LM, Valente V, et al: Sellar repair with fibrin sealant and collagen fleece after endoscopic endonasal transsphenoidal surgery. Surg Neurol 62:227-233; discussion 233, 2004
2. Castillo L, Jaklis A, Paquis P, Haddad A, Santini J: Nasal en- doscopic repair of cerebrospinal fluid rhinorrhea. Rhinology 37:33-36, 1999
3. Dodson EE, Gross CW, Swerdloff JL, Gustafson LM: Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defects: A review of twenty-nine cases. Otolaryngol Head Neck Surg 111:600-605, 1994
4. Eid M, Ibrahim A, Elwany S, Hassab M, Khamis H: Evaluation of the role of high-resolution CT and MR cisternography in preoperative identification of skull base defect in cases of CSF rhinorrhea. EJENTAS 11:17-21, 2010
5. Esposito F, Dusick JR, Fatemi N, Kelly DF: Graded repair of cranial base defects and cerebrospinal fluid leaks in trans- sphenoidal surgery. Neurosurgery 60:295-303; discussion 303-294, 2007
6. Horiguchi K, Murai H, Hasegawa Y, Hanazawa T, Yamakami I, Saeki N: Endoscopic endonasal skull base reconstruction using a nasal septal flap: Surgical results and comparison with previous reconstructions. Neurosurg Rev 33:235-241; discussion 241, 2010
7. Kim HS, Hur JW, Lee JW, Lee HK: Extraordinarily long-term posttraumatic cerebrospinal fluid fistula. J Korean Neurosurg Soc 42:403-405, 2007
8. Kumar A, Maartens NF, Kaye AH: Reconstruction of the sellar floor using Bioglue following transsphenoidal procedures. J Clin Neurosci 10:92-95, 2003
9. Meco C, Tezcaner CZ, Tuna H, Gokcan K, Attar A, Anadolu Y: Transfacial transsphenoidal gunshot wound: Endonasal endoscopic management. J Trauma 68:E94-98, 2010
10. Nishioka H, Izawa H, Ikeda Y, Namatame H, Fukami S, Haraoka J: Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery. Acta Neurochir (Wien) 151:1427-1430, 2009
11. Park JI, Strelzow VV, Friedman WH: Current management of cerebrospinal fluid rhinorrhea. Laryngoscope 93:1294-1300, 1983
12. Presutti L, Mattioli F, Villari D, Marchioni D, Alicandri-Ciufelli M: Transnasal endoscopic treatment of cerebrospinal fluid leak: 17 years experience. Acta Otorhinolaryngol Ital 29: 191-196, 2009
13. Rocchi G, Caroli E, Belli E, Salvati M, Cimatti M, Delfini R: Severe craniofacial fractures with frontobasal involvement and cerebrospinal fluid fistula: Indications for surgical repair. Surg Neurol 63:559-563; discussion 563-554, 2005
14. Sanderson JD, Kountakis SE, McMains KC: Endoscopic man- agement of cerebrospinal fluid leaks. Facial Plast Surg 25: 29-37, 2009
15. Schaefer SD, Diehl JT, Briggs WH: The diagnosis of CS rhinorrhea by metrizamide CT scanning. Laryngoscop 90:871-875, 1980
16. Schlosser RJ, Bolger WE: Endoscopic management o cerebrospinal fluid rhinorrhea. Otolaryngol Clin North A 39:523-538, 2006
17. Schick B, Weber R, Kahle G, Draf W, Lackmann GM: Lat manifestations of traumatic lesions of the anterior skull bas Skull Base Surg 7:77-83, 1997
18. Sciarretta V, Mazzatenta D, Ciarpaglini R, Pasquini E, Farne G, Frank G: Surgical repair of persisting CSF leaks followin standard or extended endoscopic transsphenoidal surger for pituitary tumor. Minim Invasive Neurosurg 53:55-59, 201
19. Singh R, Hazarika P, Nayak DR, Balakrishnan R, Hazarika M Singh A: Endoscopic repair of cerebrospinal fluid rhinorrhe Manipal experience. Indian J Otolaryngol Head Neck Sur 61:14-18, 2009
20. Sharma DP, Singh D, Sinha S, et al. CSF rhinorrhea: An ove view of endoscopic repair. IJNT 7:157-162, 2010
21. Talamonti G, Fontana R, Villa F, et al: High risk anterior basal skull fractures. Surgical treatment of 64 consecutive cases. J Neurosurg Sci 39:191-197, 1995
22. Tataranu L, Gorgan MR, Ciubotaru V, et al: Endoscopic endonasal transsphenoidal approach in the management of sellar and parasellar lesions: Indications and standard surgical technique (Part I). Romanian Neurosurgery 17:52-63, 2010
23. Van Aken MO, Feelders RA, de Marie Set al: Cerebrospinal fluid leakage during transsphenoidal surgery: Postoperative external lumbar drainage reduces the risk for meningitis. Pituitary 7:89-93, 2004
24. Wani NA, Khan AQ: Foreign body within sphenoid sinus: Mul- tidetector-row computed tomography (MDCT) demonstra- tion. Turk Neurosurg 20:547-549, 2010
25. Warnecke A, Averbeck T, Wurster U, Harmening M, Lenarz T, Stover T: Diagnostic relevance of beta2-transferrin for the detection of cerebrospinal fluid fistulas. Arch Otolaryngol Head Neck Surg 130:1178-1184, 2004
26. Welch KC, Stankiewicz J: CSF Rhinorrhea. http://emedicine. medscape.com/article/861126-overview 2011

APA	YILDIRIM A, DURSUN E, DIVANLIOGLU D, ÖZDÖL Ç, NACAR O, CORAPCI O, BELEN A (2014). Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. , 276 - 280.
Chicago	YILDIRIM Ali Erdem,DURSUN Engin,DIVANLIOGLU Denizhan,ÖZDÖL Çağatay,NACAR Osman Arıkan,CORAPCI Ovunc Erdem,BELEN Ahmed Deniz Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. (2014): 276 - 280.
MLA	YILDIRIM Ali Erdem,DURSUN Engin,DIVANLIOGLU Denizhan,ÖZDÖL Çağatay,NACAR Osman Arıkan,CORAPCI Ovunc Erdem,BELEN Ahmed Deniz Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. , 2014, ss.276 - 280.
AMA	YILDIRIM A,DURSUN E,DIVANLIOGLU D,ÖZDÖL Ç,NACAR O,CORAPCI O,BELEN A Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. . 2014; 276 - 280.
Vancouver	YILDIRIM A,DURSUN E,DIVANLIOGLU D,ÖZDÖL Ç,NACAR O,CORAPCI O,BELEN A Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. . 2014; 276 - 280.
IEEE	YILDIRIM A,DURSUN E,DIVANLIOGLU D,ÖZDÖL Ç,NACAR O,CORAPCI O,BELEN A "Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound." , ss.276 - 280, 2014.
ISNAD	YILDIRIM, Ali Erdem vd. "Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound". (2014), 276-280.

APA	YILDIRIM A, DURSUN E, DIVANLIOGLU D, ÖZDÖL Ç, NACAR O, CORAPCI O, BELEN A (2014). Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. Turkish Neurosurgery, 24(2), 276 - 280.
Chicago	YILDIRIM Ali Erdem,DURSUN Engin,DIVANLIOGLU Denizhan,ÖZDÖL Çağatay,NACAR Osman Arıkan,CORAPCI Ovunc Erdem,BELEN Ahmed Deniz Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. Turkish Neurosurgery 24, no.2 (2014): 276 - 280.
MLA	YILDIRIM Ali Erdem,DURSUN Engin,DIVANLIOGLU Denizhan,ÖZDÖL Çağatay,NACAR Osman Arıkan,CORAPCI Ovunc Erdem,BELEN Ahmed Deniz Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. Turkish Neurosurgery, vol.24, no.2, 2014, ss.276 - 280.
AMA	YILDIRIM A,DURSUN E,DIVANLIOGLU D,ÖZDÖL Ç,NACAR O,CORAPCI O,BELEN A Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. Turkish Neurosurgery. 2014; 24(2): 276 - 280.
Vancouver	YILDIRIM A,DURSUN E,DIVANLIOGLU D,ÖZDÖL Ç,NACAR O,CORAPCI O,BELEN A Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound. Turkish Neurosurgery. 2014; 24(2): 276 - 280.
IEEE	YILDIRIM A,DURSUN E,DIVANLIOGLU D,ÖZDÖL Ç,NACAR O,CORAPCI O,BELEN A "Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound." Turkish Neurosurgery, 24, ss.276 - 280, 2014.
ISNAD	YILDIRIM, Ali Erdem vd. "Unusual Posttraumatic Delayed Cerebrospinal Fluid Rhinorrhea due to Gunshot Wound". Turkish Neurosurgery 24/2 (2014), 276-280.