Article
Rare CSF fistulas: the role of Sternberg's canal, tympano-meningeal duct, the glossopharyngeal nerve and the tympanic canal
Seltene Liquorfisteln: die Rolle des Sternberg Kanals, des Ductus tympanomeningeus, des N. glossopharyngeus und des Canalis tympanicus
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Authors
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R. Behr
- Klinik für Neurochirurgie, Klinikum Fulda gAG
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M. Janka
- Klinik für Neurochirurgie, Klinikum Fulda gAG
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E. Hofmann
- Institut für diagnostische und interventionelle Neuroradiologie, Klinikum Fulda gAG
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K. Schwager
- HNO Klinik, Klinikum Fulda gAG
| Published: | May 30, 2008 |
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Outline
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Objective: CSF fistulas occur mainly after trauma, intracranial or skull base procedures. In many cases the surgeon is opposed to a major therapeutic and operative problem that often needs an interdisciplinary approach. However, the location of the fistula and its origin is known in most of these cases. The diagnostic and therapeutic problem is by far bigger in spontaneous CSF fistulas. They are often misdiagnosed because of minimal CSF flow and come into discussion after one or several bouts of meningitis.
Methods: Seven patients with spontaneous CSF fistulas and/or meningitis are reported. High resolution CT, CT cisternography and in special cases, MRI cisternography with Gadolinum as well as intrathecal fluorescein application served as diagnostic procedures. Using these techniques, the pathologies could be clearly detected. The individual operative procedures are described and were successful in all but one case.
Results: In 4 cases a persisting Sternberg's canal was found and in two additional cases, a pseudo tympano-meningeal duct (Hyrtl's fissure) was present besides the Sternberg's canal. Pseudo, because no contact to the tympanon was detected, but there was an intra-extracranial communication along the glossopharyngeal nerve into the extracranial space from the intracranial opening of Hyrtl's fissure to the extracranial area of the opening of the tympanic canal. These patients had additional bony defects of the skull base and/or meningoceles. Another patient was found to have a defect at the cribriform plate and multiple other basal defects. In this case a pseudotumor cerebri was apparent.
Conclusions: In spontaneous CSF fistulas, malformations and abnormalities of the skull base should be taken into account. Besides Sternberg's canal and Hyrtl's fissure, a new type of spontaneous fistula along the glossopharyngeal nerve is described. The multiplicity of lesions and malformations generates the idea of a general underlying principle or syndrome. Combinations of abnormalities are possible and enhance the diagnostic and therapeutic problem.
