Diagnosis and Management of Anterior CSF Leaks : Our Experience

Abstract

CSF leaks through the nose (CSF rhinorrhea) may occur due to defects in the anterior, middle or posterior cranial fossa. Among them, anterior CSF leaks are most commonly encountered in clinical practice and may be traumatic or spontaneous in origin. A prompt diagnosis is essential as the main risk of a persistent leak is the chance of developing life threatening meningitis. Radiological imaging by non-contrast high-resolution CT scan is the initial investigation of choice and shows the site of leak in most cases. In case of recent onset leaks, a period of conservative management is indicated. If conservative management fails, then the traditional neurosurgical procedures like craniotomy and other open approaches were the most preferred line of management of such leaks till a few years back. But now endoscopic repair of these leaks has provided a better alternative because of reduced surgical morbidity, hospital stay and costs. We present our initial experience with seven cases of anterior CSF rhinorrhea which were encountered in a two year period in our institute. Two out of three cases with recent onset leaks healed spontaneously with medical management while five cases required endoscopic repair with two surgical failures.