Ann Plast Reconstr Surg | Volume 3, Issue 4 | Case Report | Open Access
Wen-Xiang Gao1, Wu Jian2, Jian Bo Shi1 and Yin-Yan Lai1*
1Department of Otolaryngology, Sun Yat-sen University, China 2Department of Otolaryngology, Guangzhou Red Cross Hospital, China
*Correspondance to: Yin-Yan Lai
Fulltext PDFIntroduction: Radiation Therapy (RT) is primary treatment for Nasopharyngeal Carcinoma (NPC). Although Intensity-Modulated Radiotherapy (IMRT) can reduce the amount of radiation to normal tissues around the lesion, the amount of radiation to the lesion area is not significantly reduced. Skull base Osteoradionecrosis (ORN) is one of the most serious complications of RT and can even lead to death. This is the first published case report to our knowledge of cerebrospinal fluid leakage induced by post-RT skull base osteoradionecrosis. Case Presentation: A 60-year-old man, who diagnosed NPC staged as T1N1M0 in 2003 and received 68GY30 times RT for primary tumor, was diagnosed as “Cerebrospinal Fluid (CSF) rhinorrhea (left side); Purulent meningitis” in 2017. We did an emergency repair of the cerebrospinal fluid leakage by nasal endoscope approach and found two small dural defects where located in the lateral wall of the left sphenoid sinus just as the pre-operated CT scan. No rhinorrhea meningitis complained in the follow 2 years. But in 2019 spring, the patient complained a recurrent rhinorrhea by no incentives. We arranged CT scan and an MRI hydrography examination for the patient and found ethmoid-like defect change in bottom of the right sphenoid sinus bone this time and no tumor recurrence was observed. So we did a second time right-side endoscopic transsphenoidal approach CSF leakage repair operation. Then the patient recovered and regular endoscope follow-up showed no evidence of cerebrospinal fluid rhinorrhea. Since the patient has no history of trauma, we speculate that cerebrospinal fluid rhinorrhea is caused by bone necrosis after radiotherapy. This is a very rare case. Bone necrosis and osteoporosis after radiotherapy lead to bone defect in bilateral sphenoid sinuses at different stages leading to cerebrospinal fluid rhinorrhea. This case report is helpful for clinical study of adverse reactions of intensity modulated radiation therapy. Conclusion: Radiation Therapy (RT) is one of the most effective treatments for NPC; however, the risk of cerebrospinal fluid leakage should be considered by the use of Intensity-Modulated Radiotherapy (IMRT). Emergency surgical treatment is required when CSF leakage is identified because the leakage will not be healed with conservative treatment.
Cerebrospinal fluid; Radiation therapy; Skull base osteoradionecrosis; NPC
Gao W-X, Jian W, Bo Shi J, Lai Y-Y. Delayed CSF Leak in Intensity-Modulated Radiation Therapy for a NPC Patient. Ann Plast Reconstr Surg. 2019; 3(4): 1040..