髄液漏と外転神経麻痺をきたした蝶形骨洞炎の1例

A case of sphenoiditis with cerebrospinal fluid rhinorrhea and the abducens nerve paralysis

Ⅰ．はじめに

　蝶形骨洞および篩骨蜂巣は眼窩尖端部，海綿静脈洞に近接することから，これらの副鼻腔病変から第Ⅱ～Ⅵ脳神経に障害をきたすことがある^1,2）。

　今回，蝶形骨洞炎に外転神経麻痺，髄液漏および翼突筋部膿瘍による開口障害を合併した症例を経験したので報告する。

　A 36-year-old woman complained of headache and diplopia. CT scan showed that the sphenoid sinus was filled with soft tissue density and the clivus bone was partially destructed. Also it showed an abscess in the left pterygoid muscles. The patient underwent endoscopic sinus surgery. A large amount of pus was evacuated out of the sphenoid sinus. There was a cerebrospinal fluid leakage from the sphenoid sinus. A spinal drainage tube was inserted. Antibiotics was administered and the patient was kept on a complete rest on bed for 3 weeks after endoscopic sinus surgery. The cerebrospinal fluid leakage was controlled without further surgery. The abducens nerve paralysis was almost cured within 7 months. In this case, it was thought that the cerebrospinal fluid leakage and the abducens nerve paralysis are due to destruction of the clivus.