Management of Spontaneous CSF Rhinorrhea: An Institutional Experience

Abstract

Introduction Cerebrospinal fluid (CSF) rhinorrhea is the leakage of CSF through nasal cavity, due to abnormal communication between the arachnoid membrane and nasal mucosa. Middle-age (fourth to fifth decade) group, female gender, and obesity (body mass index > 40) are the most commonly reported risk-factors for this rare entity. In this study, we present our single center experience of spontaneous CSF rhinorrhea discussing important clinicoradiological aspects in preoperative evaluation and nuances in the endoscopic repair technique. Material and Methods A retrospective study conducted for 43 spontaneous CSF rhinorrhea patients admitted between Jan 2011 to Jan 2018 at our tertiary care center. All patients underwent endoscopic repair of the defect depending upon their site of leak. Results Mean age in our study was 36.7 ± 12.3 years (range: 9–62 years). Average BMI in males was found lower (28.7) as compared with females (32).Most common site of CSF leak was cribriform plate (n = 32, 74.4%) and Planum was found to be the least common site (n = 1, 2.3%) of CSF leak.Intraoperatively, 23 (53.5%) patients showed high-flow leak. Intrathecal injection of fluorescein dye was used to identify the site of CSF leakage in 15 cases (34.8%). The overall success rate of primary endoscopic repair in our study was 95.3%. Conclusion Spontaneous CSF rhinorrhea occurs secondary to elevated intracranial pressure, with a predilection for obese females in fourth to fifth decade. Individualized tailored surgical approach depending upon the site, size, and flow-variety of the defect forms the cornerstone of management.

Case report: Recurrent spontaneous cerebrospinal fluid (CSF) leak

“…Our patient is obese, middle-aged female, this tend to be a predisposing factor for increased intracranial pressure as per previous studies [4] , [5] , [25] . The rates of spontaneous CSF leak in the US may be increased up to 2.5-fold in high obesity regions, with correlations also found between sleep apnea and hypertension in patients with CSF leak [4] , [26] .…”

Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea—Experience from Three Southeast Asian Countries

“…These rates are superior compared to the success rates of 86% in craniotomy and extracranial methods for the surgical repair of CSF leaks [ 37 ]. A review of recent studies published over the past 5 years showed a high success rate with zero or very minimal immediate postoperative complications ( Table 6 ) [ 8 , 30 , 31 , 32 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The variable success rates of endoscopic repair most likely reflect the surgeons’ technical experience, the timing of management, and the nature of the leak (high-pressure versus low-pressure).…”

Advances in Pituitary Surgery

“…Most CSF leaks after endoscopic removal of pituitary adenoma, if present, fall within this category. In contrast, a highflow CSF leak refers to constant CSF flow caused by direct opening of the ventricles or connection with the cisterns [42,43]. It usually occurs following an extended transsphenoidal approach or in cases of revision surgery of the recurred pituitary adenoma.…”