Abstract
Spontaneous CSF rhinorrhea associated with primary empty sella is a recently recognized condition. Because of its surgical indication, the preoperative evaluation of the possible site of the fistulous tract could be of fundamental importance. Most cases of primary empty sella reported in the literature have shown evidence of leakage through the sellar floor into the sphenoid sinus, thus requiring a transphenoidal approach. Non-traumatic defects in the anterior fossa are rarely reported in the literature. We have collected three new cases in which CT cisternography with non-ionic water-soluble contrast medium ruled out the possibility of a transellar fistula, thus suggesting a possible leak in the area of the lamina cribrosa. This was confirmed by the surgical outcome and by the follow-up of each patient.
Sommario
L'associazione di rinoliquorrea spontanea con empty sella di tipo primario è stata confermata recentemente. Per l'importanza dell'indicazione chirurgica, la valutazione preoperatoria della localizzazione del passaggio liquorale assume un valore fondamentale. La maggior parte dei casi descritti in letteratura di empty sella primaria con rinoliquorrea mostravano un passaggio del liquor nel seno sfenoidale attraverso il pavimento sellare. In questi casi l'approccio chirurgico era di tipo transfenoidale. Solo rari casi di alterazioni in fossa cranica anteriore con conseguente rinoliquorrea di tipo non-traumatico sono stati documentati in letteratura. Vengono qui riportati tre nuovi casi in cui una cisternografia con mezzo di contrasto solubile non-ionico seguita da uno studio con tomografia computerizzata, ha permesso l'esclusione di una fistola transellare e ha suggerito il possibile passaggio attraverso la lamina cribra. Ogni caso descritto ebbe conferma chirurgica e follow-up positivo.
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Perani, D., Scotti, G., Colombo, N. et al. Spontaneous CSF rhinorrhea through the lamina cribrosa associated with primary empty sella. Ital J Neuro Sci 5, 167–172 (1984). https://doi.org/10.1007/BF02043218
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DOI: https://doi.org/10.1007/BF02043218