Spontaneous CSF Rhinorrhea: Prevalence of Multiple Simultaneous Skull Base Defects

Lieberman, Seth; Chen, Si; Jethanamest, Daniel; Casiano, Roy R.

doi:10.2500/ajra.2015.29.4121

Cited by 25 publications

(20 citation statements)

References 11 publications

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“…The pathogenesis of CSF rhinorrhea is unclear, but previous studies have hypothesized that prolonged ICH may lead to defects in the skull base over time. These defects coupled with ICH can cause herniation of the dura mater into the bony defects, weakening the dura mater and making it more prone to dural tears and thus leading to a dural-mucosal fistula [5]. Similarly, obesity causes increased intra-abdominal pressure, leading to the elevation of the diaphragm and thereby leading to increased pleural and cardiac pressures, thus decreasing venous return from the brain to the heart and causing ICH [3,6].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

Boppana¹,

Welch²,

Calderon³

2020

Cureus

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Cerebrospinal fluid (CSF) rhinorrhea refers to the loss of CSF through the nasal cavity. Its causes can be classified as either spontaneous or non-spontaneous. Spontaneous causes of CSF rhinorrhea include congenital anatomical defects and are extremely rare, accounting for less than 4% of reported cases. Following failure of conservative management, definitive treatment most commonly involves an endoscopic transsphenoidal repair of the defect. We present a case of spontaneous CSF rhinorrhea in a previously well 52-year-old female, which required surgical intervention due to failure of conservative management.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

Boppana¹,

Welch²,

Calderon³

2020

Cureus

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“…Investigators have identified several potential risk factors for this syndrome such as elevated body mass index (BMI), obstructive sleep apnea (OSA), and intracranial hypertension [ 3 – 6 ]. Although the exact pathogenesis of spontaneous CSF rhinorrhea is not known, investigators have speculated that defects in the skull base may develop as a result of elevated intracranial pressures [ 7 ]. One explanation is that individuals who have a predisposition to this syndrome and develop intracranial hypertension may spontaneously form a dural-mucosal fistula.…”

Section: Discussionmentioning

confidence: 99%

Recurrent CSF Rhinorrhea Misdiagnosed as Chronic Allergic Rhinitis with Subsequent Development of Bacterial Meningitis

Ulrich

Loo

Ing

2017

Case Reports in Medicine

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Introduction Cerebrospinal fluid (CSF) rhinorrhea results from an abnormal communication of the dura mater to the nasal mucosa. The majority of cases of CSF rhinorrhea are the result of trauma or surgery involving the skull base. Spontaneous CSF rhinorrhea is a rare clinical entity with increased risk of ascending infection. Delay in diagnosis places the patient at risk of developing meningitis. Case Presentation A 36-year-old African American female with significant medical history of obesity and hypertension presented to the emergency department with headache, altered level of consciousness, fever, and neck stiffness. Previously, the patient was diagnosed with chronic allergic sinusitis by multiple providers. Physical exam findings and laboratory tests were consistent with bacterial meningitis. The patient was admitted and started on appropriate antibiotic therapy. The patient continued to complain of persistent unilateral clear nasal drainage. The initial report from the computerized tomography scan of the sinuses indicated findings consistent with chronic sinusitis. Magnetic resonance imaging of the orbits revealed findings consistent with CSF rhinorrhea. Otolaryngology was consulted for surgical intervention. Conclusion Suspected CSF rhinorrhea should prompt immediate biochemical and radiologic evaluation and surgical consultation. CSF rhinorrhea places patients at risk of developing bacterial meningitis.

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“…Through this defect, the dura may herniate and form meningoceles or, if the defect is big, the cerebral parenchyma can also herniate through (encephalocele) 8 . A study conducted by Lieberman et al on patients with spontaneous CSF rhinorrhea proved that they had multiple simultaneous bony defects in the skull base 4 . The researchers found that intracranial hypertension represents a determining factor for the appearance of these defects.…”

Section: Spontaneous Csf Leaksmentioning

confidence: 99%

“…The underlying condition that leads to CSF discharge into the nasal cavities is the disruption of the limits between the rhinosinusal cavities and the anterior and middle cerebral fossae. The communication with the central nervous system may determine multiple infectious complications, with high morbidity and potentially severe patient outcome 3,4 . Most frequently, we encounter CSF leaks in the anterior cerebral fossa, because it has the most sites of congenital weakness and also the sites that are related to the specific surgery type.…”

Section: Pathophysiologymentioning

confidence: 99%

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Patrascu¹,

Manea²,

Sarafoleanu³

2017

Romanian Journal of Rhinology

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A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

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Spontaneous CSF Rhinorrhea: Prevalence of Multiple Simultaneous Skull Base Defects

Abstract: A significant number of patients with spontaneous CSF rhinorrhea may have more than one skull base defect present at the time of presentation. The clinical significance of this finding in surgical and medical decision making is not clear at this time.

Cited by 25 publications

References 11 publications

Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

Recurrent CSF Rhinorrhea Misdiagnosed as Chronic Allergic Rhinitis with Subsequent Development of Bacterial Meningitis

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

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