Obstructive Sleep Apnea Syndrome Revealing an Osteomeningeal Breach: A Case Report

Abstract

Osteomeningeal breach is a discontinuity in the osteomeningeal layer that allows cerebrospinal fluid to flow into an air-filled cavity at the base of the skull. Its severity is associated with the risk of central nervous system infection. The majority of breaches are traumatic in origin, either accidental or iatrogenic. Spontaneous cerebrospinal fluid rhinorrhea is less commonly found. Obesity, often coupled to obstructive sleep apnea syndrome, can lead to hypercapnia, increasing the pressure of cerebrospinal fluid and thereby facilitating the development of osteomeningeal breaches. In cases of intracranial hypertension, the displacement of the pituitary gland can occur, and as a result, its cavity can be filled with cerebrospinal fluid, which characteristically describes an empty sella turcica syndrome. We present the case of a 52-year-old woman initially admitted for the management of sleep apnea syndrome, along with a history of chronic rhinorrhea. Analysis of the rhinorrhea fluid and craniofacial imaging revealed a cerebrospinal fluid leak through a breach in the right cribriform plate, associated with an empty sella turcica syndrome. The patient underwent surgical repair of the meningeal breach via an endonasal approach, leading to a successful resolution of cerebrospinal fluid rhinorrhea.