術中に外傷性髄液鼻漏が発覚し閉鎖術を行った1例

A case of intraoperative closure of a traumatic spinal fluid rhinorrhoea discovered intraoperatively

はじめに

　髄液鼻漏は，鼻副鼻腔と頭蓋内が交通することで生じ，原因により，外傷性，医原性，特発性に分類される^1）。髄液鼻漏の臨床症状は，透明な片側性の鼻汁が特徴的であり^2），その他の症状としては反復する髄膜炎や慢性的な頭痛，痙攣発作，めまいなどがみられることもある^3）。近い過去に明らかな外傷がなく，漿液性鼻漏のみの場合，漿液性鼻漏を髄液鼻漏であると疑いを持つことが診断の第一段階となる^4）。今回われわれは，術中に外傷性髄液鼻漏が発覚し閉鎖術を行った症例を経験したので，若干の文献的考察を加え報告する。

　The patient was a 53-year-old woman who underwent endoscopic sinus surgery. Intraoperatively, however, it was discovered that she had a medullary rhinorrhea. She was able to close it by the Onlay method using the free mucosa of the inferior nasal duct. We diagnosed the patient as having traumatic CSF rhinorrhea, as his symptoms appeared after he fell down. In order to prevent such an unexpected situation from occurring, we reaffirmed the importance of careful preoperative interview and careful reading of sinus CT, keeping in mind the possibility of CSF rhinorrhea when examining a patient with intractable rhinorrhea.