Rinorree cerebrospinali

https://doi.org/10.1016/S1639-870X(11)70658-4Get rights and content

La constatazione di una rinorrea cerebrospinale testimonia la presenza di una breccia osteomeningea. L’otorinolaringoiatra deve conoscere bene questa situazione in quanto è il primo a poter individuare una rinorrea cerebrospinale e a poter intraprendere esami che conducano a questa diagnosi. Di origine spontanea, il suo carattere di solito monolaterale deve far pensare ad essa per confermare la sua origine e iniziare un’indagine esaustiva per individuare la sede della perdita di liquor cerebrospinale e per ripararla prima della comparsa di altri sintomi o complicanze. Il ruolo della β2-transferrina e della β-trace è essenziale per identificare il liquor cerebrospinale. La diagnostica per immagini, in particolare la TC spirale, permette di localizzare perfettamente la breccia e la risonanza magnetica associata a delle sequenze particolari può apportare delle precisazioni nei casi difficili o può permettere di precisare l’importanza e il contenuto di un meningoencefalocele sospettato al momento della TC. La riparazione per via endoscopica endonasale ha preso in 20 anni il posto delle vie esterne in particolare neurochirurgiche, ottenendo dei tassi di successo dell’85–90% in quasi tutte le casistiche pubblicate dal 1990. Qualunque sia la tecnica di riparazione utilizzata per via endoscopica, il tasso di successo è del 90% circa e la morbilità è bassa. Gli obiettivi sono, qui, di precisare la conduzione delle indagini che portano a individuare e a localizzare l’origine della perdita di liquor cerebrospinale e di descrivere le tecniche chirurgiche moderne e le modalità di gestione nonché le indicazioni terapeutiche.

Riferimenti bibliografici (100)

  • C.A. Righini et al.

    Reconstruction after tumor resection of the anterior skull base with an of abdominal fat graft

    Ann Otolaryngol Chir Cervicofac

    (2005)
  • W. Bolger

    Endoscopic transpterygoid approach to the lateral sphenoid recess: surgical approach and clinical experience

    Otolaryngol Head Neck Surg

    (2005)
  • J. Lang

    The anterior and middle cranial fossae including the cavernous sinus and orbit

  • H.M. Schmidt

    Uber Maβe und niveaudifferenzen der medianstrukturen der vorderen schâdelgrube des menschen

    Geg Morph J

    (1974)
  • J. Lang

    Clinical anatomy of the nose, nasal cavity and paranasal sinuses

    (1989)
  • C. Righini et al.

    Elargissement optimal de l’abord des sinus frontaux. Note technique

    J Fr ORL

    (1997)
  • J. Mouret

    Le schéma des masses latérales de l’ethmoïde

    Rev Laryngol Otol Rhinol (Bord)

    (1922)
  • M.G. Yasargil

    Anatomical observations of the subarachnoid cisterns of the brain during surgery

    J Neurosurg

    (1976)
  • E.N. Marieb

    Anatomie et physiologie humaine

    (1999)
  • G.A. Westmore et al.

    Cerebrospinal fluid rhinorrhea and its management

    Pr J Surg

    (1982)
  • J. Chabannes et al.

    Problèmes diagnostics et thérapeutiques des brèches ostéoméningées et des fistules traumatiques de l’étage antérieur de la base du crâne

    Neurochirurgie

    (1987)
  • Pelisse JM. Les rhinorrhées cérébrospinales. EMC (Elsevier Masson SAS, Paris), Oto-rhino-laryngologie, 20-365-A-10,...
  • C. Righini et al.

    Traitement chirurgical sous contrôle endoscopique des rhinorrhées cérébroscpinales d’origine sphénoïdale. À propos de 5 cas

    Ann Otolaryngol Chir Cervicofac

    (1996)
  • A.K. Ommaya et al.

    Non traumatic cerebrospinal fluid rhinorrhea

    J Neurol Neurosurg Psychiatry

    (1968)
  • H.H. Kaufman

    Non traumatic cerebrospinal fluid rhinorrhea

    Arch Neurol

    (1969)
  • A.C. Hooper

    Sphenoidal defect: a possible cause of cerebrospinal fluid rhinorrhea

    J Neurol Neurosurg Psychiatry

    (1971)
  • B. Schick et al.

    Stenberg's canal. Cause of congenital sphenoidal meningocele

    Eur Arch Otorhinolaryngol

    (2000)
  • H.A. Jenkins et al.

    Spontaneous cerebrospinal rhinorrhea from the sphenoid sinus

    Trans Ann Acad Ophtalmol Oto-Laryngol

    (1977)
  • T. Onishi

    Bony defects and dehiscences of the roof of the ethmoid cells

    Rhinology

    (1981)
  • D. Woscoboimik et al.

    Les rhinorrhées non traumatiques hypertensives, à propos d’un cas

    Neurochirurgie

    (1988)
  • R.L. Rovit et al.

    Spontaneous “high pressure cerebrospinal rhinorrhea” due to lesions obstructing flow of cerebrospinal fluid

    J Neurosurg

    (1969)
  • F.T. Dagi et al.

    Management of cerebrospinal fluid leaks

  • J.A. Stankiewicz

    Cerebrospinal fluid fistula and endoscopic sinus surgery

    Laryngoscope

    (1991)
  • C. Snyderman et al.

    Endoscopic reconstruction of cranial base defects following endonasal skull base surgery

    Skull Base

    (2007)
  • P. Castelnuovo et al.

    Endonasal Endoscopic Repair of Sternberg's Canal Cerebrospinal Fluid Leaks

    Laryngoscope

    (2007)
  • S. Lai et al.

    Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus

    Laryngoscope

    (2002)
  • R. Carrau et al.

    The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus

    Laryngoscope

    (2005)
  • R. Schlosser et al.

    Elevated inracranial pressure in spontaneous cerebrosinal leaks

    Am J Rhinol

    (2003)
  • Klossek JM, Fontanel JP, Bataille B, Dufour X. Rhinorrhée cérébrospinale. EMC (Elsevier Masson SAS, Paris),...
  • S.K. Wise et al.

    Evaluation of nasal spontaeous cerebrospinal fluid leaks

    Curr Opin Otolaryngol Head Neck Surg

    (2007)
  • S. Schmerber et al.

    Méthodes d’identification et de localisation des brèches ostéo-méningées ethmoïdo-sphénoïdales

    Rev Laryngol Otol Rhinol (Bord)

    (2001)
  • S. Schmerber et al.

    Endonasal endoscopic closure of cerebrospinal fluid rhinorrhea

    Skull Base

    (2001)
  • J.M. Hilinski et al.

    Posttraumatic pseudo-cerebrospinal fluid rhinorrhea

    Otol Neurotol

    (2001)
  • M.J. Middelweerd et al.

    A new biochemical assay in the diagnostic management of nasal cerebrospinal fluid leakage

    Eur Arch Otolaryngol

    (1995)
  • C. Schnabel et al.

    Comparison of β2-transferrin and β-trace protein for detection of cerebrospinal fluid in nasal and ear fluids

    Clin Chem

    (2004)
  • C. Meco et al.

    Efficacy of cerebrospinal fluid fistula repair: sensitive quality control using the beta-trace protein

    Am J Rhinol

    (2007)
  • M. Hamilton Sampaio et al.

    Predictability of quantification of beta-trace protein for diagnosis of cerebrospinal fluid leak: Cutoff determination in nasal fluids with two control groups

    Am J Rhinol Allergy

    (2009)
  • R. Rajeswaran et al.

    Role of MR cisternography in the diagnosis of cerebrospinal fluid rhinorrhoea with diagnostic nasal endoscopy and surgical correlation

    Ind J Radiol Imag

    (2006)
  • P.G. Shetty et al.

    Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula

    AJNR Am J Neuroradiol

    (1998)
  • P.N. Jayakumar et al.

    3D steady-state MR cisternography in CSF rhinorrhea

    Acta Radiol

    (2001)

    • Cited by (0)

    View full text
    Copyright © 2011 Elsevier Masson. All rights reserved.