Spontaneous cerebrospinal fluid leak of posterior surface of temporal bone: Review and case report

Abstract

Aim. To analyze the rarity of the clinical case report on spontaneous liquorrhea (SL) posterior cranial fossa (PCF) together with a review of the literature. To determine the features of PCF SL in contrast to anterior and middle cranial fossa (MCF) SL. To identify the optimal diagnostic and treatment tactics in patients with PCF SL. Materials and methods: We present clinical observations of a PCF SL patient and a detailed review of reports on SL with a defect on the posterior border of the petrous temporal bone (PTB). Results: Based on the literature review, 22 cases with a sufficient description were analyzed. PCF SL occurs more commonly in women than in men; middle-aged and elderly patients prevail. The average body mass index (BMI) was 33.3 ± 7, corresponding to a degree I obesity. The number of postoperative complications was quite large; each included recurrent liquorrhea. Conclusion: The data from our experience and a literature review for PCF SL patients are comparable with those of similar studies of SL in the anterior and MCF. Middle-aged and elderly women with excessive BMI are the most vulnerable. In most patients, the defect is located in the lateral regions of the posterior border of the PTB, namely anteriorly, medially from the sigmoid sinus, and below the upper petrosal sinus. A fairly high percentage of postoperative complications is due to insufficient preoperative diagnosis or intraoperative examination of the posterior PTB in patients with combined MCF and PCF defects, causing revision surgery. Clinical significance. If rhinorrhea, otorrhoea, and/or signs of intracranial space integrity loss (pneumocerephaly or latent liquorrhea with recurrent meningitis) are revealed, careful examination of bone structures of the anterior, middle, and also, be sure PCF is required, especially at the intersection with paranasal sinuses (frontal, ethmoidal, sphenoid) and mastoid air cells and PTB.