Delayed cerebrospinal fluid leak post-intensity-modulated radiotherapy for nasopharyngeal carcinoma: a case report
-
Abstract: A 60-year-old man, who diagnosed nasopharyngeal carcinoma staged as T1N1M0 in 2003 and received 68 Gy 30 times intensity modulated radiotherapy for primary tumor, was diagnosed as "cerebrospinal fluid rhinorrhea(left side); purulent meningitis; nasopharyngeal carcinoma(post-radiotherapy) " in 2017. The patient received an emergency repair of the cerebrospinal fluid leakage by nasal endoscope approach surgery. No rhinorrhea complained in the following 2 years. But two years later, the patient complained a recurrent rhinorrhea by no incentives. The CT scan found ethmoid-like defect change in bottom of the right sphenoid sinus bone this time and no tumor recurrence was observed in CT scan or MRI exam. Then the patient received a second time right-side endoscopic transphenoid approach cerebrospinal fluid leakage repair operation. The patient recovered well after operation and regular endoscope follow-up showed no evidence of cerebrospinal fluid rhinorrhea. This case showed that the risk of cerebrospinal fluid leakage should be considered by the use of intensity modulated radiotherapy. For the cerebrospinal fluid rhinorrhea caused by osteonecrosis after radiotherapy, emergency surgical treatment is required since conservative treatment may not be effective.
-
Key words:
- nasopharyngeal neoplasms /
- cerebrospinal fluid /
- radiotherapy
-
[1] McMains KC, Gross CW, Kountakis SE. Endoscopic management of cerebrospinal fluid rhinorrhea[J]. Laryngoscope, 2004, 114(10): 1833-1837. doi: 10.1097/00005537-200410000-00029
[2] Han P, Wang X, Liang F, et al. Osteoradionecrosis of the Skull Base in Nasopharyngeal Carcinoma: Incidence and Risk Factors[J]. Int J Radiat Oncol Biol Phys, 2018, 102(3): 552-555. doi: 10.1016/j.ijrobp.2018.06.027
[3] Wang HC, Hwang JC, Peng JP, et al. Tension pneumocephalus--a rare complication of radiotherapy: a case report[J]. J Emerg Med, 2006, 31(4): 387-389. doi: 10.1016/j.jemermed.2006.04.013
[4] Jimenez-Jimenez E, Martí SS, Villas MV. Tension pneumocephalus related to radiotherapy for nasopharyngeal carcinoma[J]. Case Rep Oncol Med, 2014, 2014: 327380.
[5] Chen Y, Liu MZ, Liang SB, et al. Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of china[J]. Int J Radiat Oncol Biol Phys, 2008, 71(5): 1356-1364. doi: 10.1016/j.ijrobp.2007.12.028
[6] Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment[J]. Br J Oral Maxillofac Surg, 2008, 46(8): 653-660. doi: 10.1016/j.bjoms.2008.04.006
[7] Law SC, Lam WK, Ng MF, et al. Reirradiation of nasopharyngeal carcinoma with intracavitary mold brachytherapy: an effective means of local salvage[J]. Int J Radiat Oncol Biol Phys, 2002, 54(4): 1095-1113. doi: 10.1016/S0360-3016(02)03009-2
[8] Abdel Khalek Abdel Razek A, King A. MRI and CT of nasopharyngeal carcinoma[J]. AJR Am J Roentgenol, 2012, 198(1): 11-18. doi: 10.2214/AJR.11.6954
[9] 林裕茂, 张乃崇, 赖廷海. 鼻咽癌放疗患者行内窥镜下修补脑脊液鼻漏术的疗效观察[J]. 实用医学杂志, 2011, 27(13): 2410-2411. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201113046.htm
[10] 姜婷婷, 王卫华, 马兆鑫. 放射治疗后鼻内镜手术致脑脊液鼻漏2例[J]. 中国眼耳鼻喉科杂志, 2015, 15(3): 208-209. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH201503022.htm
[11] 张维天, 殷善开. 内镜下带血管蒂鼻中隔黏骨膜瓣修复颅底缺损[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(6): 463-468. doi: 10.3760/cma.j.issn.1673-0860.2011.06.006
[12] 张力元, 陆雪官, 田野. 鼻咽癌脑脊液鼻漏1例报告[J]. 临床肿瘤学杂志, 2004, 9(2): 216-216. doi: 10.3969/j.issn.1009-0460.2004.02.045