Giant atypical posterior fossa meningioma revealed by rhinorrhea

Objective and importance: Cerebral supra or infratentorial tumors associated with chronic intracranial hypertension and hydrocephalus may rarely generate spontaneous, non-traumatic rhinorrhea. We report one case of this rare condition with a giant atypical left posterior fossa meningioma and right nostril rhinorrhea. Clinical presentation: A 55-years-old woman was admitted for a 16-year history of headache, 1-year of right nostril rhinorrhea, which was exacerbated when the patient was standing or when she bent forward, ataxia, astasia-abasia. Spontaneous rhinorrhea (no previous history of head trauma or meningitis) stopped suddenly a few days before admission, while cephaleea increased and her general condition worsened. Native and contrast CT scan disclosed a giant extraaxial tumor: 7/9/8 cm, developed in the left posterior fossa, but also active, internal, supratentorial hydrocephalus. The anterior recess of the third ventricle was dilated; with a small discontinuity of the right spenoid sinus. Intervention: The microsurgical resection of the tumor mass was subtotal, as confirmed by postop CT scan, induced by cardiac rhythm fluctuation and tensional oscillations. After the operation the patient became free of CSF leakage and a direct approach for rhinorrhea was not needed. Conclusion: A case of non-traumatic spontaneous rhinorrhea generated by a giant atypical left posterior fossa, atypical meningioma is described. Using microsurgical resection, the tumor was subtotally removed, the patient improved and rhinorrhea didn’t recur.