Primary Spontaneous Inferior Clival Cerebrospinal Fluid Leak

Abstract

Primary, spontaneous cerebrospinal fluid (CSF) leaks secondary to defects in the clivus are exceedingly rare. Additionally, primary, spontaneous CSF leaks are typically present in obese women with idiopathic intracranial hypertension (IIH). In the present study, we report the first case of a primary, spontaneous CSF leak in the inferior-posterior wall of the clivus in an atypical patient with a BMI of 18.9 kg/m 2 without IIH. Accurate diagnoses of CSF leaks are imperative in the context of preventing meningitis, and delays in diagnosis and treatment are associated with worse outcomes. Improved characterization of rare, spontaneous CSF leaks may prove beneficial in correctly diagnosing affected patients.

Spontaneous Cerebrospinal Fluid Leakage at the Clivus: Minimally Invasive Surgery Without External Autograft Harvesting

“…For skull base reconstructions due to spontaneous CSF leakage at the clivus, previous studies have reported harvesting autografts and conducting a multilayered reconstruction (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13]. However, these techniques require invasive procedures outside the main surgical site, i.e., the endonasal area, to harvest the reconstructive material.…”

“…Regarding the diagnosis of this condition, half of these patients have a history of meningitis before the diagnosis of CSF leakage [1][2][3][4][5][6][8][9][10][11][12], and all have serous rhinorrhea [1][2][3][4][5][6][7][8][9][11][12][13]. This is a characteristic course of the condition but may be overlooked because of the rarity of the condition itself.…”

“…Such leaks at the clivus are particularly rare [1,2]. These are thought to be related to excessive aerification of the sphenoid sinus, chronic intracranial hypertension, and pulsation of the basilar artery [2][3][4][5]. Various transsphenoidal reconstruction methods have been reported previously [1][2][3][4][5][6][7][8][9][10][11][12][13].…”

“…Most fistulas related to CSF leakage at the clivus are only a few millimeters in diameter [2,3,13], and previous reports have used fat or fascia for their reconstruction, which requires the invasion of a site other than the nose for the harvesting of autograft material [1][2][3][4][5][6][7][8][9][10][11][12][13].…”