• François Lechanoine, Ilyess Zemmoura, and Stéphane Velut.
• Neurosurgery Department, CHRU de Tours, Tours, France; Brain and Imaging, Université François-Rabelais de Tours, UMR Inserm U930, Tours, France.
• World Neurosurg. 2017 Dec 1; 108: 990.e1-990.e9.

BackgroundChoroid plexus papilloma revealed by nontraumatic cerebrospinal fluid (CSF) rhinorrhea has only been described 5 times, to our knowledge, in the literature. The challenges in this situation are to recognize CSF leak, to rapidly understand the pathophysiology of the leak, and to choose the best treatment strategy in emergency. We report an original case of posterior fossa choroid plexus papilloma revealed by CSF leak. We then discuss the surgical strategy and the pathophysiology of CSF leak, which is explained, in this case, by both hyperproduction of CSF and local skull base erosion.Case DescriptionWe report the case of a 47-year-old man who has developed spontaneous rhinorrhea, right hearing loss, and confusion. A choroid plexus papilloma of the right cerebellomedullary cistern was diagnosed. Hydrocephalus and pneumocephalus were associated with an erosion of the homolateral skull base. The patient underwent surgical total tumor removal by a median suboccipital approach after implantation of a temporary external ventricular drainage. The patient recovered completely without any recurrence of CSF rhinorrhea. The 5-month postoperative images show total bone re-growth and resolution of hydrocephalus.ConclusionsOur case shows that 1) causal reasoning is of major importance when dealing with CSF rhinorrhea and that 2) dura repair can be avoided when treating CSF leak secondary to posterior fossa choroid plexus papilloma.Copyright © 2017 Elsevier Inc. All rights reserved.

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