Treating CSF Rhinorrhea without Dura Repair - A Case Report of Posterior Fossa Choroid Plexus Papilloma.

Treating CSF Rhinorrhea without Dura Repair - A Case Report of Posterior Fossa Choroid Plexus Papilloma.

World Neurosurg. 2017 Aug 30;:

Authors: Resident FL, Zemmoura I, Velut S

Abstract
BACKGROUND: Choroid plexus papilloma revealed by non traumatic cerebrospinal fluid (CSF) rhinorrhea had only been described five times in the literature. The challenges in this situation are to recognize CSF leak, to rapidly understand the pathophysiology of the leak, and to choose the best treatment strategy in emergency. We report an original case of posterior fossa choroid plexus papilloma revealed by CSF leak. We then discuss the surgical strategy and the pathophysiology of CSF leak, which is explained, in this case, by both hyperproduction of CSF and local skull base erosion.
CASE DESCRIPTION: We report the case of a 47-years-old male who has developed spontaneous rhinorrhea, right hearing loss and confusion. A choroid plexus papilloma of the right cerebellomedullary cistern was diagnosed. Hydrocephalus and pneumocephalus was associated to an erosion of the homolateral skull base. The patient underwent surgical total tumor removal by a median suboccipital approach after implantation of a temporary external ventricular drainage. The patient recovered completely without any recurrence of CSF rhinorrhea. The 5-months postoperative images show total bone re-growth and resolution of hydrocephalus.
CONCLUSIONS: Our case shows that (1) causal reasoning is of major importance when dealing with CSF rhinorrhea, and that (2) dura repair can be avoided when treating CSF leak secondary to posterior fossa choroid plexus papilloma.

PMID: 28866068 [PubMed - as supplied by publisher]

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