Spontaneous Cerebrospinal Fluid Leak at the Clivus: Two Case Reports and Literature Review

Abstract

Spontaneous or non-traumatic cerebrospinal fluid leaks comprise 5-10% of all CSF rhinorrhea. Generally, CSF rhinorrhea occur at Cribriform plate, sella, sphenoid sinus and ethmoid air. Primary CSF rhinorrhea from clival defect is extremely rare. We herein describe two cases of spontaneous CSF rhinorrhea through the clivus repaired with endoscopic endonasal trans sphenoid approach. Moreover, we collected evidence in the literature regarding potential etiology, symptom and treatment (which occurred in the case reported).

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.…”

“…Spontaneous cerebrospinal fluid (CSF) leakage is relatively rare, accounting for approximately 5-10% of all types of CSF leaks [ 1 ]. Such leaks at the clivus are particularly rare [ 1 , 2 ].…”

“…Spontaneous cerebrospinal fluid (CSF) leakage is relatively rare, accounting for approximately 5-10% of all types of CSF leaks [1]. 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].…”

“…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].…”