Meningite e fistula liquorica recidivantes em traumatismo cranio-encefalico frontobasal: registro de um caso

Silva, José A. Gonçalves da; Silva, Erasmo Barros da; Cantisani Filho, Jim U.

doi:10.1590/S0004-282X1980000200006

Resumos

É relatado um caso de traumatismo frontobasal com lesão isolada do seio esfenoidal esquerdo, cujas complicações foram meningite e fistula liquórica. Ocorreram 3 surtos de meningite, respectivamente 5, 8 e 11 anos após o traumatismo. A fistula liquórica foi observada pela primeira vez 8 anos após o traumatismo, permanecendo intermitente durante 6 anos. O tratamento consistiu na obliteração do pertuito fistuloso mediante craniotomia bifrontal.

A case of fronto-basal traumatism with isolated fracture of the left sphenoidal sinus is reported. Meningitis occured 5, 8 and 11 years, respectively, after injury. Cerebrospinal fluid cranio-nasal fistula was observed at the first time 8 years after injury and remained intermitent in the last 6 years. The surgical technic was accomphished according to the procedure devised by Dietz and consisted of plastics of the anterior floor of the skull accompanied by galea-periosteal junction taken out from the scalp.

Meningite e fistula liquorica recidivantes em traumatismo cranio-encefalico frontobasal: registro de um caso

Recurrent meningitis and cerebrospinal fluid rhinorrhoea in fronto-basal head injury: report of a case

José A. Gonçalves da Silva^I; Erasmo Barros da Silva^II; Jim U. Cantisani Filho^III

^IProfessor de Clínica Neurocirúrgica. Centro de Ciências da Saúde da Universidade Federal da Paraíba

^IIProfessor Colaborador. Centro de Ciências da Saúde da Universidade Federal da Paraíba

^IIIResidente de Neurocirurgia. Centro de Ciências da Saúde da Universidade Federal da Paraíba

SUMARIO

É relatado um caso de traumatismo frontobasal com lesão isolada do seio esfenoidal esquerdo, cujas complicações foram meningite e fistula liquórica. Ocorreram 3 surtos de meningite, respectivamente 5, 8 e 11 anos após o traumatismo. A fistula liquórica foi observada pela primeira vez 8 anos após o traumatismo, permanecendo intermitente durante 6 anos. O tratamento consistiu na obliteração do pertuito fistuloso mediante craniotomia bifrontal.

SUMMARY

A case of fronto-basal traumatism with isolated fracture of the left sphenoidal sinus is reported. Meningitis occured 5, 8 and 11 years, respectively, after injury. Cerebrospinal fluid cranio-nasal fistula was observed at the first time 8 years after injury and remained intermitent in the last 6 years. The surgical technic was accomphished according to the procedure devised by Dietz and consisted of plastics of the anterior floor of the skull accompanied by galea-periosteal junction taken out from the scalp.

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Hospital São Vicente de Paulo - 58000 João Pessoa, PB - Brasil.

1. ALBRECHT, K. - Die entzündlichen Komplikationen des Schftdeltrauma und ihre Behandlung. Zbl. Chir. 86:1611, 1961.
2. CRANDAL.L, P. H. - Post-traumatic cranial defects in the anterior fossa. Amer. J. Surg. 93:517, 1957.
3. DAVIS, R. E. - A case of recurrent meningitis with cerebro-spinal fluid rhinorrhoea. Med. J. Aust. 50:931, 1963.
4. DIETZ, H.; BROCK, M.; SCHÜRMANN, K.; ZEITLER, E. & WOLí, R. -Scintigraphic visualization of the site of dural and bone defectsi following frontonasal head injuries. Third European Congress of Neurosurgery, Madrid, 23-26--04-1967. Excerpta med. (Amsterdam), Int. Congress- Series 139:93, 1967.
5. DIETZ,' H. - Die frontobasale Schfidelhirnverletzung. Springer-Verlag Berlin--Heidelberg-New York, 1970.
6. GONÇALVES DA SILVA, J. A. & GONÇALVES DA SILVA, C. E. - Traumatismos crânio-encefálicos frontobasais-: a propósito de 10 casos operados. Arq. Neuro--Psiquiat. (São Paulo) 33:140, 1975.
7. KLEINFELD, M.; AXELROD, M. & COHEN, A. - Recurrent meningitis and cerebrospinal rhinorrhea. N. Y. State J. Med. 50.1244, 1950.
8. KLEY, W. - Diagnostik und operative Versorgung von Keilbeinhtthlenfrakturen. Z. Laryng. Rhinol. 46:469, 1967.
9. LANG, H. - Beobachtungsergebnisse innerhalb von 8 Jahren bei 2019 Schftdel-traumen mit 222 Schftdelgrundbrüchen. Bruns' Beitr. 172:101, 1941.
10. LEITHOLF. O. - Traumatische Optikusschttdigungen. Zbl. Neurochir. 20:19, 1960.
11. LEWIN. W. - Cerebrospinal fluid rhinorrhoea in closed head injuries. British J. Surg. 42:1, 1954.
12. LEWIN, W. & CAIRNS, H. - Fractures of the sphenoidal sinus with cerebrospinal rhinorrhoea. British med. J. 6:1, 1951.
13. LINELL, E. A. & ROBINSON, W. L. - Head injuries and meningitis. J. Neurol Psychiatr. (London) 4:23, 1941.
14. LOEBELL, G. - Zur Differentialdiagnose der rhinogenen Liquorrhoe. Pract. oto-rhino-laryng. (Basel) 22:235, 1960.
15. LOESER, R. & ACKERMANN. R. - XIV. Eitrige Meningitiden: die nasale Liquor-fistel als Ursache. Med. Welt 17:2078. 1966.
16. LOVE, J. G. & GAY, J. R. - Spontaneous cerebrospinal rhinorrhea: successful surgical treatment. Arch. Otolaryng. 46:40, 1947.
17. LUCKETT, W. H. - Air in the ventricles of the brain, following a fracture of the skull: report of a case. Surg. Gyn. Obstet. 17:237, 1913.
18. McKISSOCK, W. - Fractures of the anterior fossa of the skull. Ann. Roy. Coll. Surg. Engl. 11:218, 1952.
19. MURPHREE. H. C. & BROUSSARD, W. J. - Pneumocephalus associated with injury of orbit: a case report. J. Neurosurg. 23:450, 1965.
20. SCHÜRMANN, K. - Offene Schttdelhirnverletzungen. Chirurg 38:356, 1967.
21. SEEGER. W. - Frontobasale Frakturen. Dtsch. med. Wschr. 92:1009, 1967.

Datas de Publicação

Publicação nesta coleção
23 Ago 2012
Data do Fascículo
Jun 1980

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALBRECHT, K. - Die entzündlichen Komplikationen des Schftdeltrauma und ihre Behandlung. Zbl. Chir. 86:1611, 1961.

[2] 2. CRANDAL.L, P. H. - Post-traumatic cranial defects in the anterior fossa. Amer. J. Surg. 93:517, 1957.

[3] 3. DAVIS, R. E. - A case of recurrent meningitis with cerebro-spinal fluid rhinorrhoea. Med. J. Aust. 50:931, 1963.

[4] 4. DIETZ, H.; BROCK, M.; SCHÜRMANN, K.; ZEITLER, E. & WOLí, R. -Scintigraphic visualization of the site of dural and bone defectsi following frontonasal head injuries. Third European Congress of Neurosurgery, Madrid, 23-26--04-1967. Excerpta med. (Amsterdam), Int. Congress- Series 139:93, 1967.

[5] 5. DIETZ,' H. - Die frontobasale Schfidelhirnverletzung. Springer-Verlag Berlin--Heidelberg-New York, 1970.

[6] 6. GONÇALVES DA SILVA, J. A. & GONÇALVES DA SILVA, C. E. - Traumatismos crânio-encefálicos frontobasais-: a propósito de 10 casos operados. Arq. Neuro--Psiquiat. (São Paulo) 33:140, 1975.

[7] 7. KLEINFELD, M.; AXELROD, M. & COHEN, A. - Recurrent meningitis and cerebrospinal rhinorrhea. N. Y. State J. Med. 50.1244, 1950.

[8] 8. KLEY, W. - Diagnostik und operative Versorgung von Keilbeinhtthlenfrakturen. Z. Laryng. Rhinol. 46:469, 1967.

[9] 9. LANG, H. - Beobachtungsergebnisse innerhalb von 8 Jahren bei 2019 Schftdel-traumen mit 222 Schftdelgrundbrüchen. Bruns' Beitr. 172:101, 1941.

[10] 10. LEITHOLF. O. - Traumatische Optikusschttdigungen. Zbl. Neurochir. 20:19, 1960.

[11] 11. LEWIN. W. - Cerebrospinal fluid rhinorrhoea in closed head injuries. British J. Surg. 42:1, 1954.

[12] 12. LEWIN, W. & CAIRNS, H. - Fractures of the sphenoidal sinus with cerebrospinal rhinorrhoea. British med. J. 6:1, 1951.

[13] 13. LINELL, E. A. & ROBINSON, W. L. - Head injuries and meningitis. J. Neurol Psychiatr. (London) 4:23, 1941.

[14] 14. LOEBELL, G. - Zur Differentialdiagnose der rhinogenen Liquorrhoe. Pract. oto-rhino-laryng. (Basel) 22:235, 1960.

[15] 15. LOESER, R. & ACKERMANN. R. - XIV. Eitrige Meningitiden: die nasale Liquor-fistel als Ursache. Med. Welt 17:2078. 1966.

[16] 16. LOVE, J. G. & GAY, J. R. - Spontaneous cerebrospinal rhinorrhea: successful surgical treatment. Arch. Otolaryng. 46:40, 1947.

[17] 17. LUCKETT, W. H. - Air in the ventricles of the brain, following a fracture of the skull: report of a case. Surg. Gyn. Obstet. 17:237, 1913.

[18] 18. McKISSOCK, W. - Fractures of the anterior fossa of the skull. Ann. Roy. Coll. Surg. Engl. 11:218, 1952.

[19] 19. MURPHREE. H. C. & BROUSSARD, W. J. - Pneumocephalus associated with injury of orbit: a case report. J. Neurosurg. 23:450, 1965.

[20] 20. SCHÜRMANN, K. - Offene Schttdelhirnverletzungen. Chirurg 38:356, 1967.

[21] 21. SEEGER. W. - Frontobasale Frakturen. Dtsch. med. Wschr. 92:1009, 1967.