Unilateral rhinorrhea after translabyrinthine surgery due to parasympathetic hypersensitive syndrome: differentiation from cerebrospinal fluid leakage.
BACKGROUND
Unilateral rhinorrhea after translabyrinthine surgery for vestibular or facial schwannoma usually suggests cerebrospinal fluid (CSF) leakage and requires specific measures, including revision surgery.


OBJECTIVE
To draw attention to the possibility of postoperative unilateral rhinorrhea with concomitant hyperlacrimation and hypersialorrhea without a CSF origin and reflecting more a neuroplastic phenomenon.


METHODS
Retrospective study in a tertiary care center university clinic.


METHODS
For 1 case of intratemporal facial schwannoma and 2 cases of vestibular schwannoma, surgery was by a translabyrinthine approach with sacrifice of the facial nerve and hypoglossofacial anastomosis in the first case. Postoperative unilateral hydrorhinorrhea associated with various degrees of lacrimation and/or salivary hypersecretion occurred mainly during exercise or under stressful situations.


CONCLUSIONS
With unilateral rhinorrhea after translabyrinthine surgery for vestibular or facial schwannoma, concomitant symptoms such as lacrimation or hypersialorrhea may not be explained by CSF leakage through the eustachian tube. Misinterpretation may lead to detrimental revision surgery. The pathophysiogenetic mechanism suggests a neuroplastic phenomenon involving a denervation hypersensitivity reaction of the autonomous system. A simple diagnostic test with a nasal anticholinergic agent may be beneficial.
Huy
Patrice Tran Ba
PT
Department of Otorhinolaryngology, Head and Neck Surgery, Lariboisiere Hospital, Paris, France. patrice.tran-ba-huy@lrb.aphp.fr
Sauvaget
Elisabeth
E
D000281:Administration, Intranasal; D000328:Adult; D000714:Anastomosis, Surgical; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000473:pathology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis*; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D003390:Cranial Nerve Neoplasms / Q000601:surgery; D003937:Diagnosis, Differential; D007758:Ear, Inner / Q000601:surgery*; D005154:Facial Nerve / Q000601:surgery; D005155:Facial Nerve Diseases / Q000601:surgery; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery; D009464:Neuroma, Acoustic / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
D018680:Cholinergic Antagonists