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Cerebrospinal fluid otorrhea at myringotomy. A meningocele through a defect in the tegmen
1Department of Otolaryngology, Guy's Hospital, London, U.K.
Abstract:
Spontaneous cerebrospinal fistulae can simulate secretory otitis media or be discovered at myringotomy, but the diagnosis is frequently made after one or more episodes of meningitis. Congenital perilabyrinthine fistulae are extremely rare, and unlike translabyrinthine fistulae there is usually no sensorineural hearing loss. This is the first reported case of a congenital meningocele through the tegmen in a child. An 11-year-old boy presented with signs and symptoms which mimicked serous otitis media. A cerebrospinal fistula was produced at myringotomy and this was closed surgically via an endaural approach. A CT scan defined a defect in the tegmen tympani anterior to the superior semicircular canal.
Insights
Congenital cerebrospinal fistulae can mimic otitis media, often diagnosed after meningitis. This case details a rare congenital meningocele through the tegmen tympani in a child, successfully treated surgically.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Neurology
Background:
- Spontaneous cerebrospinal fistulae are rare and can present insidiously, often mimicking common middle ear conditions.
- Congenital perilabyrinthine fistulae are exceptionally uncommon, typically not associated with sensorineural hearing loss.
Observation:
- An 11-year-old boy presented with symptoms suggestive of serous otitis media.
- Cerebrospinal fluid (CSF) leak was identified during myringotomy.
- A defect in the tegmen tympani was visualized on CT scan.
Findings:
- This report describes the first case of a congenital meningocele through the tegmen tympani in a pediatric patient.
- The meningocele presented as a spontaneous cerebrospinal fistula.
- Surgical closure via an endaural approach was successful.
Implications:
- Highlights the importance of considering congenital cerebrospinal fistulae in pediatric patients with recurrent ear issues or meningitis.
- Demonstrates the efficacy of surgical intervention for congenital tegmen defects.
- Contributes to understanding rare congenital anomalies of the temporal bone and meninges.