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Clinical Note |

Spontaneous Cerebrospinal Fluid Rhinorrhea of the Foramen Cecum in Adulthood

Megan M. Gaffey, MD; Mark E. Friedel, MD, MPH; Girish M. Fatterpekar, MD; James K. Liu, MD; Jean Anderson Eloy, MD
Arch Otolaryngol Head Neck Surg. 2012;138(1):79-82. doi:10.1001/archoto.2011.217.
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Spontaneous cerebrospinal (CSF) rhinorrhea is a well-known entity, representing approximately 5% of all CSF leaks. These leaks usually originate from the lamina lateralis, lamina cribrosa, fovea ethmoidalis, and lateral sphenoid recess. We discuss a highly unusual case of spontaneous CSF rhinorrhea emanating from a foramen cecum defect in the posterior frontal sinus table; describe the presentation, imaging findings, and surgical repair; and provide a possible explanation for its origin. A review of the literature revealed no previous similar case.

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Figure 1. Computed tomographic (CT) scans of the paranasal sinuses. Axial (A) and sagittal (C) CT scans of the paranasal sinuses reveal a patent foramen cecum (arrow) in the posterior wall of the frontal sinus. A coronal CT cisternogram (B) revealed minimal extravasation of contrast material through this defect (arrow).

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Figure 2. Intraoperative photographs through the modified Lothrop approach. A, The Lothrop cavity with the foramen cecum (FC) is evident in the midline (arrow). B, After the bone is drilled at the FC, the dural defect (asterisk) is exposed. C, The defect is repaired with an inlay of acellular dermal allograft (asterisk). D, An overlay of acellular dermal allograft is added to the first graft and covered with gentamicin-soaked gelfoam (GF). ISS indicates intersinus septum; LFS, left frontal sinus; and RFS, right frontal sinus.

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Figure 3. An axial computed tomogram (A) and a magnetic resonance image (B) show a patent Lothrop cavity 7 months after surgery.




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Spontaneous cerebrospinal fluid rhinorrhea of the foramen cecum in adulthood. Arch Otolaryngol Head Neck Surg 2012;138(1):79-82.