特発性鼻性髄液漏

SPONTANEOUS CEREBROSPINAL FLUID RHINORRHEA

　鼻腔より髄液の漏出することは，外傷（手術を含む）に原因するばあいが多く，何ら原因のあきらかでない，いわゆる特発性鼻性髄液漏は比較的稀である。髄液性の鼻汁はその性状から鼻アレルギーの鼻汁と類似しているために，患者は鼻アレルギーの診断をうけ，その治療をうけていることが少なくない。しかし髄膜炎をおこす可能性がつよいため，診断と治療を適切に行なうことが必要である。

　ここで，原因，漏出部位のことなる特発性鼻性髄液漏の2例につき報告し考察を加えた。

　Two cases of unilateral spontaneous cerebrospinal fluid rhinorrhea are reported.

　Case 1 : A 39-year-old female developed a cerebrospinal fluid (CSF) rhinorrhea without any apparent cause. The patient suffered meningitis on 2 occasions in the period of 3 years before surgical intervention was made. A dehiscence of 5 mm in diameter was found in the roof of the lateral recess and it was obliterated by placing a fascia on the bony surface of the roof. No recurrence of CSF leakage was seen after surgery.

　Case 2 : A 72-year-old male complained of watery nasal discharge for the recent two and half years. A diagnosis of empty sella syndromewas made. No CSF leakage was noted following obliteration of the sella with a piece of muscle employing Hardy's technique. However, the patient died of myocardial infarction 3 weeks post-operatively. Autopsy revealed a markedly atrophied hypophysis and a large opening in the diaphragma sellae.

　These cases had previously been treated under the diagnosis of nasal allergy. As the CSF rhinorrhea is a potential danger to meningitis, precise diagnosis followed by surgical treatment is mandatory.