Double Skull Base Defects with Primary Spontaneous Cerebrospinal Fluid Leaks in a Single Patient: Temporal and Sphenoid Bones

Abstract

Primary spontaneous cerebrospinal fluid leaks occurring in the absence of any apparent cause are rare. Patients may present such leaks simultaneously, or successively, in multiple locations. We report here the sixth case of anterior and lateral skull base defects presented in a single patient. Although rhinoliquorrhea and otoliquorrhea were reported separately in the literature, we postulated that the pathophysiology is the same for the whole skull base; obesity seems to contribute to the development of such primary spontaneous cerebrospinal fluid leak. Consequently, management is similar and regular follow-up is very important.

Multifocal Skull Base Defects With Associated Spontaneous Cerebrospinal Fluid Leaks

“…There are limited studies examining the prevalence, demographics, and outcomes of patients suffering from multifocal spontaneous CSF leaks. Current data are limited to case reports (6)(7)(8) and case series (9)(10)(11)(12). The definition of multifocal skull base defects varies considerably across studies, further confounding interpretation of these data.…”

The runny nose

“…While the exact etiology is unknown, there have been a number of theories postulated: such as embryologic development defect or aberrant arachnoid granulations. The most common sites of skull base leaks are at the floor of the anterior cranial fossa and sphenoid sinus, the cribriform plate being the thinnest bone wall of the area [3]. The risk factors include body mass index higher than 30, female gender, middle age, and low bone density (particularly evidence of osteoporosis) [3].…”

“…The most common sites of skull base leaks are at the floor of the anterior cranial fossa and sphenoid sinus, the cribriform plate being the thinnest bone wall of the area [3]. The risk factors include body mass index higher than 30, female gender, middle age, and low bone density (particularly evidence of osteoporosis) [3]. This condition may have devastating complications in some patients such as CNS infections, decreased intracranial pressure, and brain herniation.…”