Case ReportTreating Cerebrospinal Fluid Rhinorrhea without Dura Repair: A Case Report of Posterior Fossa Choroid Plexus Papilloma and Review of the Literature
Introduction
Nontraumatic cerebrospinal fluid (CSF) rhinorrhea1 represents only 3%–4% of rhinorrheas. They have different classifications, mostly according to CSF pressure.2 The causes of high-pressure CSF leaks are hydrocephalus, tumors, and idiopathic intracranial hypertension.3, 4, 5, 6, 7 This latter entity demonstrates that elevation of the intracranial pressure can, by itself, cause the leak. In the case of tumor, the mechanism of CSF leak could be direct, by erosion of meninges and bone, or indirect, by pressure erosion of anatomically fragile areas of the skull base.2, 8, 9 The treatment of a CSF leak is an emergency because of the risk of meningitis. The 2 challenges in this situation are 1) to rapidly identify the cause of the CSF leak and 2) to treat the leak to avoid or to help antibiotic treatment of meningitis.
We report the case of a patient treated for a spontaneous CSF rhinorrhea who presented with a posterior fossa choroid plexus papilloma (CPP). Only 5 cases of CSF rhinorrhea secondary to a CPP have been previously reported, to our knowledge.9, 10, 11, 12 Beyond the rarity of this clinical entity, the main interest of this case is to demonstrate that treatment of the CSF leak can be achieved by treating the cause, i.e., removal of the CPP, without dura repair.
Section snippets
Case Report
Written informed consent was obtained from the patient for publication of this case report and the accompanying images.
Discussion
We report the case of a patient with spontaneous CSF leak treated by etiological treatment—surgical removal of a CPP of the cerebellomedullary cistern—without dura repair. Beyond the difficulty of diagnosis, the originalities of this case are 1) to discuss the pathophysiology of CSF leak associated with CPP and 2) to show that, in this case, surgery should focus on removing the CPP rather than on trying to treat at any cost both the primary cause and the dural fistula.
We found 5 cases of CSF
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Rapidly growing, multifocal, benign choroid plexus tumor in an infant: Case report
2019, Journal of Neurosurgery: Pediatrics
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.