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07-OCTOBER-2003 AYSHEH ABDALLA AL-JAABARY 43
YEARS CSF LEAK FROM THE LEFT OLFACTORY BULB FOSSA WITH EMPTY SELLA SYNDROME.
Anamnesis
The patient came to the clinic 04-October-2003
complaining of CSF leak from the left nostril
for 2 months. 18 months ago got RTA with minor
head injury. The patient performed CT-scan brain
with Omnipaque and MRI with gadolinium confirmed
that the leak is from the area of the left
olfactory bulb. There is an empty sella
syndrome.
On examination: the patient has headache with
anosmia left side. When putting the patient with
the face down the couch, the CSF coming with
massive quantity. The patient neurologically
free and tried all conservative measures to stop
the CSF leak.
Bifrontal osteoplastic
craniotomy with reflection of the bone flap to
the right ear. The dura was opened parallel to
the anterior edge of the bone defect. Dissection
of both olfactory bulbs and the tacks down to
the trigone. The chiasmatic cistern was
opened and the sellar cavity inspected for any
bony defect. Nothing was found. For precaution a
sufficient piece of muscle was fulfilled at the
floor of the empty sella with preservation of
the pituitary stalk. Inspection of the left
olfactory bulb for nearby bony defect. Nothing
found. It was necessary to sacrifice the
olfactory bulb and explore the substantia
crebrosa. It seem to have dural defect, which
was filled by muscle aided with glue. Inspection
of the right olfactory bulb was uneventful and
was left intact. Routine closure of the wound.
FOLLOW UP
The patient
came to the clinic 19-October-2003 with some ooze
from the right subgalial spaces. The patient was
advised to change dressing as necessary.
The patient
then came 28-January-2008 with no CSF leak , but
complaining of loss of hearing right side and having
chronic right mastoiditis. She was give medications
and to be consulted by ENT specialists.
The patient
then came 19-April-2008 with mild right facial
paresis after performed mastoidectomy
27-February-2008 . The patient was sent for
investigation.
The patient
then came 20-October-2008 with MRI done
24-April-2008 showing huge glomus jugulare tumor
reaching down the right CCA bifurcation. She was
advised for radiation and embolisation, if
failed then surgery.
The patient
then came 03-December-2018 with huge mass in the
right side of the neck . The patient was advised to
undergo radiation and to come 2 years of radiation
for evaluation.
Comments
Preservation of the olfactory bulb is
impossible, when the CSF leak take over in the
substantia crebrosa under it.
May be in the future approaching the substantia
crebrosa from the nasal cavity can preserve the
bulb. But the patient has anosmia in this side.
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