Published online Jul 16, 2025. doi: 10.12998/wjcc.v13.i20.102279
Revised: February 21, 2025
Accepted: March 8, 2025
Published online: July 16, 2025
Processing time: 177 Days and 16.1 Hours
Cerebrospinal fluid (CSF) leaks in the temporal bone arise from osteodural defects, resulting in an abnormal connection between the subarachnoid space and the adjacent tympanomastoid cavity, which often manifests as otorrhea. Patients typically exhibit symptoms such as headache, unilateral hearing impairment, aural fullness, or even meningitis. Imaging studies are critical for identifying and differentiating the location and characteristics of CSF leaks. However, when the leak's origin remains ambiguous, diagnostic surgery may be warranted to both confirm the diagnosis and facilitate treatment. This report discusses an uncom
The patient, a 58-year-old man, was admitted for evaluation of left ear fullness, hearing loss, and nasal discharge. Notably, when supine, clear fluid drained from the left nasal cavity, with improvement noted upon sitting. A nasal examination did not reveal significant findings, while the otologic evaluation indicated an intact periosteum; however, considerable fluid accumulation was identified within the left middle ear. Despite undergoing multiple periosteal punctures and conservative medical management, the middle ear effusion persisted. Imaging studies, including magnetic resonance imaging (MRI) and computed tomography, confirmed the presence of left-sided CSF otorrhea, and the head MRI indicated potential CSF rhinorrhea. This raised challenges in determining whether the CSF leak originated from the sphenoid sinus or the temporal bone. Given that CSF otorrhea may drain through the external auditory canal and CSF rhinorrhea from the sellar region can present as nasal leakage, differentiation proved complex. In this case, with an intact external auditory canal, CSF from the middle ear was observed to flow into the nasal cavity via the Eustachian tube. Therefore, leakage from both sites could be misconstrued as CSF rhinorrhea, complicating the diagnostic process. Consequently, an exploratory surgical procedure was performed, revealing an incomplete dura mater on the temporal aspect of the petrous bone, which was subsequently repaired.
Benign intracranial hypertension can result in meningeal protrusion or meningoencephalocele, which may lead to CSF leakage that generally responds favorably to mucosal repair. In instances where imaging fails to identify the source of the leak or when diagnostic options are limited, proactive exploratory surgery is advisable. Although surgical interventions carry inherent risks, the application of endoscopic techniques by experienced surgeons renders this approach a feasible choice for addressing both diagnostic and therapeutic challenges.
Core Tip: This case report details a 58-year-old male patient diagnosed with temporal bone cerebrospinal fluid leaks. The complexity of the case stemmed from the atypical configuration of the defect at the leakage site, compounded by difficulties in preoperative differential diagnosis due to the presence of an empty sella and a defect in the petrous bone identified on computed tomography and magnetic resonance imaging. Following extensive discussions, the patient underwent an exploratory procedure, successfully repairing the dura mater defect. The efficacy of mucosal repair under endoscopic guidance was highlighted as a promising approach in such clinical scenarios.