Relato de caso: otoliquorreia espontânea em adulto / Case study spontaneous otoliquorrhea in adult

Introdução: As fístulas liquóricas otológicas espontâneas (FLOEs) são entidades raras. Geralmente manifestam-se em crianças com meningite e perda sensorioneural profunda e em adultos com quadro de otite média com efusão. Objetivo: Descrever o quadro clínico, o diagnóstico e o tratamento cirúrgico de uma paciente com FLOE. Relato do Caso: Paciente do sexo feminino, 57 anos, com história de hipoacusia, plenitude aural e tinnitus à direita há 10 anos. Após colocação de tubo de ventilação à direita em outro serviço, iniciou otorreia líquida, transparente e constante em grande quantidade. O diagnóstico foi realizado através da cisternocintilografia, sugestiva de fístula liquórica; e da cisternotomografia que mostrou área de deiscência óssea em região de tegmen tympani à direita, velamento parcial de células mastóideas e de orelha média à direita, além concentração do meio de contraste no espaço sub-aracnoídeo à direita menor em relação ao lado esquerdo. Através de via transmastoídea foi localizada fístula liquórica e meningoencefalocele na região de tegmen tympani à direita. O fechamento da fístula foi realizado através do uso de retalho de músculo temporal, cola de fibrina e Surgicel®. Comentários Finais: Em adultos com história clínica sugestiva de otite média com efusão recorrente, a hipótese diagnóstica de fístula liquórica deve ser levantada. A investigação deve prosseguir com exames de imagem, destacando-se a cisternotomografia. O tratamento cirúrgico nesta paciente, através da técnica transmastoídea, se revelou eficaz a curto e a longo prazo...

Introduction: The spontaneous otological CSF leaks are rare entities. Usually they manifest themselves in children with meningitis and deep sensorineural hearing loss and in adults with middle otitis and effusion clinical picture. Objective: To describe the clinical picture, diagnosis and surgical treatment of a patient with CSF otological. Case Report: A female sex patient, 57 years old, with hearing loss, aural fullness and right ear tinnitus case history 10 years ago. After insertion of tympanostomy tubes on the right in another service, it began liquid, transparent and constant otorrhea in large quantities. The diagnosis was performed by suggestive cisternoscintigraphy of CSF leak, and by cisternography that showed that the area of bone dehiscence in the tegmen tympani region to the right, partial opacification of mastoid cells and middle ear to the right, besides concentration of contrast medium in sub-arachnoid space to the lower right compared to the left side. Through transmastoid via was located the CSF leak and meningoencephalocele in the region of the right tegmen tympani. The closure of the fistula was accomplished through the use of the temporal muscle flap, fibrin glue and Surgicel®. Final Comments: In adults with symptoms suggestive of recurrent otitis media with effusion, the diagnosis of CSF fistula should be raised. The research should proceed with imaging, highlighting the CTC. Surgical treatment in this patient using the transmastoid technique has proved effective in the short and long term...

Current imaging of cerebrospinal fluid leaks / Imágenes médicas actuales de pérdidas de fluido cerebroespinal

A CSF leak results from a defect in the dura and skull base. Due to the risk of potentially devastating central nervous system infection, it is an important entity. Timely diagnosis of CSF leaks is crucial. Laboratory testing of nasal or aural fluid drainage for the presence of the protein Beta(β)-2 transferrin plays a key role in establishing the presence of a CSF leak. Such assays are not always available, making imaging pivotal in the diagnosis of this entity. The development of minimally invasive endoscopic repair further underscores the importance of imaging as precise anatomic localization is important for repair. In this article, we review the literature and make suggestions for the appropriate radiological investigation ofpatients with suspected CSF leaks.

Las pérdidas de fluido cerebroespinal (FCE) son el resultado de un defecto en la dura y la base craneal. Debido a que tales pérdidas presentan el riesgo de infecciones capaces de devastar potencialmente el sistema nervioso central, las mismas constituyen una entidad importante. El diagnóstico a tiempo de pérdidas del FCE es crucial. Las pruebas de laboratorio realizadas al drenaje del fluido de la nariz y los oídos a fin de detectar la proteína Beta (β) 2 transferrina, desempeñan un papel clave a la hora de determinar la presencia de pérdida de FCE. Estos ensayos no se hallan siempre a disposición, con lo cual la imagen médica se hace fundamental para el diagnóstico de esta entidad. El desarrollo de reparaciones endoscópicas mínimamente invasivas subraya aún más la importancia de la imagen médica, por cuanto se requiere una localización anatómica precisa para realizar la reparación. En el presente artículo, se revisa la literatura y se hacen sugerencias a fin de lograr una investigación radiológica adecuada de los pacientes con sospecha de pérdida de FCE.

Current imaging of cerebrospinal fluid leaks.

A CSF leak results from a defect in the dura and skull base. Due to the risk of potentially devastating central nervous system infection, it is an important entity. Timely diagnosis of CSF leaks is crucial. Laboratory testing of nasal or aural fluid drainage for the presence of the protein Beta (beta)-2 transferrin plays a key role in establishing the presence of a CSF leak. Such assays are not always available, making imaging pivotal in the diagnosis of this entity. The development of minimally invasive endoscopic repair further underscores the importance of imaging as precise anatomic localization is important for repair In this article, we review the literature and make suggestions for the appropriate radiological investigation of patients with suspected CSF leaks.

Cerebrospinal fluid masquarading as secretory otitis media

O autor apresenta três casos de fluido cérebro-espinhal, na cavidade tímpano-mastóidea, simulando otite média secretora