Primary spontaneous cerebrospinal fluid rhinorrhea

Abstract

Spontaneous cerebrospinal fluid (CSF) rhinorrhea constitutes only 3% to 4% of CSF fistulas. Nontraumatic, normal pressure CSF fistulas with resultant rhinorrhea, in which no cause can be identified, or primary spontaneous CSF rhinorrhea, is considerably rarer. Presented here are two cases of CSF rhinorrhea of this nature, including the diagnostic workup and treatment. Reviews of literature support laboratory quantitative glucose determination as the most effective and least morbid method for confirming the presence of CSF. Iodine-contrast (metrizamide/lohexol) computerized tomographic cisternography has been shown to be the most effective and least morbid method for localizing the fistula. For inactive, intermittent, small, or questionable CSF leaks, radionuclide cisternography has been shown to be more effective in identifying the presence of these leaks, although not necessarily the location. Numerous reports provide evidence to support the use of an extracranial rhinologic approach for surgical repair of the leak, as a more successful yet less morbid procedure than a craniotomy when used appropriately.

Study on Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhoea: A Birmingham Experience

“…Spontaneous CSF rhinorrhoea occurs in 3-4% of all cases 1 , where normal pressure CSF leaks (55%) outnumber the high pressure CSF leaks (45%).…”

Nontraumatic (Spontaneous) Cerebrospinal Fluid Rhinorrhea from Cribriform Fistula Associated with Primary Empty Sella: Report of Two Cases and Literature Review

“…Fluorescein dyes, 19 radioisotopes, 20 metrizamide digital video subtraction fluoroscopic cisternography, 21 and contrast CT cisternography, 20,22,23 have all been used to determine the location of CSF leak. The latter, however, has proved invaluable, and is the test of choice.…”

Diagnostic and Therapeutic Sinonasal Endoscopy in Pediatric Patients

“…According to Ommaya's classification (Ommaya, 1976), CSF leaks can be divided into non-traumatic (with high or normal CSF pressure) and traumatic (accidental or iatrogenic lesion). About 80% and 16% of CSF leaks are due to head trauma and sinuses or skull base surgery, respectively (Beckhardt et al, 1991). Spontaneous fistulae, which are more frequent in obese females in the fourth decade of life (Pianta et al, 2005), represent 3-4% of cases (Beckhardt et al, 1991;Yerkes et al, 1992;Nachtigal et al, 1999;Schlosser & Bolger, 2002).…”

“…About 80% and 16% of CSF leaks are due to head trauma and sinuses or skull base surgery, respectively (Beckhardt et al, 1991). Spontaneous fistulae, which are more frequent in obese females in the fourth decade of life (Pianta et al, 2005), represent 3-4% of cases (Beckhardt et al, 1991;Yerkes et al, 1992;Nachtigal et al, 1999;Schlosser & Bolger, 2002). Moreover, skull base tumors or other congenital lesions (such as untreated aqueductal stenosis) may cause CSF leaks directly through erosion of the skull base or indirectly through the development of hydrocephalus.…”

“…When the lesion is located in the temporal bone, CSF reaches the nasopharynxc via the Eustachian tube and becomes evident in most cases as bilateral clear rhinorrhea (Pianta et al, 2005). Patients with intermittent CSF leak complain frequently of headache, which appears whenever rhinorrhea stops and the CSF pressure increases (Beckhardt et al, 1991). Finally, signs and symptoms such as headache, vomit, or edema of the papilla are suggestive for intracranial hypertension (Pianta et al, 2005).…”