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August 1944


Arch Surg. 1944;49(2):75-85. doi:10.1001/archsurg.1944.01230020080001

In rhinorrhea and otorrhea the cerebrospinal fluid is discharged from the nose and the ear respectively. Both conditions are due to a fistula connecting the cerebrospinal spaces—either the subarachnoid spaces or the ventricular system—with the exterior. Pneumocephalus (air in the cranial chamber) is frequently but not necessarily in association. If the fistula is large enough, air enters the cranial chamber as the fluid passes out. When there is a ball valve arrangement in the fistulous tract, coughing and sneezing may force large quantities of air into the cranial chamber, and if the frontal lobes are pierced a steadily enlarging air-filled cavity in a frontal lobe gradually erodes its way into a lateral ventricle, and the entire ventricular systern together with the subarachnoid spaces is then filled with air; this is the terminal stage. The surgical attack on rhinorrhea and otorrhea, however, is precisely the same, for both are due to

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