Spontaneous cerebrospinal fluid leak at the clivus.

Abstract

We present a case report of a 60-year-old woman with a spontaneous cerebrospinal fluid leak at the clivus, obesity and no history of trauma. Follow-up imaging scans confirmed enlargement of the defect within the posterior clival framework to the size of 16 × 9 × 4 mm with a suspected meningocerebral hernia. The surgeons used the “two nostrils – four hands” endoscopic operating technique. The patient reported a history of cerebrospinal fluid leaks lasting for 3 years, with increasingly shorter leak-free periods and an increasing incidence of inflammatory complications. The patient recovered without complications, and she was discharged 14 days after the surgery. Good local outcome and improved patient condition were achieved postoperatively.

Spontaneous cerebrospinal fluid rhinorrhea

“…Spontaneous cerebrospinal fluid leakage is usually caused by developmental abnormalities and is rare, accounting for approximately 5% of the cases of cerebrospinal fluid (CSF) leakage. [ 1 ] To the best of our knowledge, clival dysplasia-caused CSF rhinorrhea has never been reported in the neurosurgical field.…”

“… Abstract

Introduction: Spontaneous cerebrospinal fluid leakage is usually caused by developmental abnormalities and is rare, accounting for approximately 5% of the cases of cerebrospinal fluid (CSF) leakage. [ 1 ] To the best of our knowledge, clival dysplasia-caused CSF rhinorrhea has never been reported in the neurosurgical field.

Conclusion: Spontaneous cerebrospinal fluid rhinorrhea is often treated by surgery, and a transsphenoidal approach repair is the main surgical method used, offering the advantages of less trauma, fewer complications, rapid postoperative recovery, and low recurrence rate.

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Clival defect in the pathogenesis of recurrent meningitis: a case report and literature review

“…The prevalence of S-CSF-L of all CSF fistulas in any location is between 3 and 40% in the series [4][5][6][7]. S-CSF-L is usually observed at the cribriform plate of the skull base.…”

“…CSF leakage due to primary defects and/or fracture of the clivus, or osteomyelitis of the clivus might lead to meningitis and recurrent meningitis [5][6][7][8][9][10][11][12][13]. Table 1 summarizes the published characteristics of meningitis cases that include clivus defects.…”

“…In the cases where clival defect was eventually found, the reasons outlined for the recurrences included a failure to give surgical consent following the first episode [5], ineffective first surgery [7], inappropriate antibiotherapy course for osteomyelitis [8], and misidentification of the exact leak site [9]. It is our understanding that the patient discussed herein was misdiagnosed following previous episodes.…”