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[Spontaneous cerebrospinal fluid fistula in association with congenital inner ear anomaly: a case report]
Abstract:
A case of inner ear anomaly (Mondini dysplasia) associated with recurrent meningitis found in a 10 year-old boy is reported. The patient had suffered from bacterial meningitis and CSF rhinorrhea five times in 7 years. The origin of CSF leakage had not been detected by bifrontal craniotomy or trans-sphenoidal operation. In May 1985, the dysplasia of the temporal bone and the inner ear had been pointed out by an otologist. And he underwent operations a few times for closing the CSF fistula at the floor of the internal auditory meatus by translabyrinthine approaches, but in vain. On the 7th of November 1985, under the control of intracranial pressure by continuous ventricular drainage, re-operation was performed. Packing the internal auditory meatus with several pieces of muscle and gelatine sponge stopped the CSF leakage and the recurrence of meningitis.
Insights
Mondini dysplasia, an inner ear anomaly, was linked to recurrent bacterial meningitis and cerebrospinal fluid (CSF) leakage in a young boy. Surgical packing of the internal auditory meatus successfully resolved the CSF leak and prevented meningitis recurrence.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Neurology
Background:
- Recurrent bacterial meningitis in children can be a debilitating condition.
- Cerebrospinal fluid (CSF) leaks, particularly from the inner ear, pose a diagnostic challenge.
- Mondini dysplasia is a congenital inner ear malformation that can predispose individuals to meningitis.
Observation:
- A 10-year-old boy experienced five episodes of bacterial meningitis and CSF rhinorrhea over seven years.
- Previous surgical interventions, including bifrontal craniotomy and trans-sphenoidal operations, failed to identify the CSF leak origin.
- An otologist identified Mondini dysplasia, an inner ear anomaly, as a potential cause.
Findings:
- Multiple translabyrinthine approaches to close the CSF fistula at the internal auditory meatus were unsuccessful.
- A re-operation, with intracranial pressure controlled by continuous ventricular drainage, was performed.
- Packing the internal auditory meatus with muscle and gelatine sponge effectively stopped the CSF leakage and prevented meningitis recurrence.
Implications:
- This case highlights the association between Mondini dysplasia and recurrent meningitis due to CSF leakage.
- It underscores the importance of considering inner ear anomalies in cases of unexplained recurrent meningitis.
- Successful surgical management involving packing of the internal auditory meatus offers a potential treatment strategy for such complex cases.