Spontaneous Recurrent CSF Rhinorrhoea: A Rare Case and Review of Literature

Abstract

Cerebrospinal fluid (CSF) rhinorrhoea is the leakage of CSF through the communication between the subarachnoid space and the nasal cavity. Surgical repair is indicated in all cases of spontaneous leaks, recurrent leaks, leaks that do not stop after conservative management and cases with history of meningitis. We present a rare case of spontaneous (delayed onset post traumatic) CSF rhinorrhoea with multiple defect sites, which was treated with an endonasal endoscopic repair. The patient was asymptomatic for 9 years after surgery, and then presented with a spontaneous left frontal recess CSF leak, which was closed using endonasal approach.

Keywords: CT cisternography; Endonasal endoscopic repair; High pressure CSF leaks; Meningitis; Multiple defect CSF leak; Recurrent cerebrospinal fluid rhinorrhoea; β-2-Transferrin.

Fig. 1

Coronal CT scan with cisternography showing defect in right cribriform plate

Fig. 2

Coronal CT scan with cisternography showing defect in left anterior fovea (red arrow)

Fig. 3

Coronal CT scan with cisternography showing defect in infero-lateral wall of right sphenoid sinus

Fig. 4

Operative photo showing encephalocele with CSF leak in infero-lateral wall of right sphenoid sinus, seen by 45° endoscope

Fig. 5

Operative photo showing encephalocele with CSF leak in right cribriform plate, seen by 45 endoscope

Fig. 6

Operative photo showing encephalocele in left anterior fovea, seen by 45 endoscope

Fig. 7

Operative photo showing left anterior fovea defect closed with septal cartilage