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. 2023 Jul 29;15(7):e42661.
doi: 10.7759/cureus.42661. eCollection 2023 Jul.

The Etiology, Diagnosis, and Management of Cerebrospinal Fluid Rhinorrhea: A Tertiary Center Experience

Faisal A Noori  1   2 , Dalia M Hamdan  1   2 , Yousef I Alaqsam  1   2 , Dakheelallah A Almutairi  3   1   2
Affiliations

The Etiology, Diagnosis, and Management of Cerebrospinal Fluid Rhinorrhea: A Tertiary Center Experience

Faisal A Noori et al. Cureus. .

Abstract

Introduction The aim of the present study was to describe our institution's nine years of experience in the endoscopic endonasal management of cerebrospinal fluid (CSF) rhinorrhea and to discuss the causes, sites, and outcomes. Methodology The medical records of patients diagnosed with CSF rhinorrhea in King Abdulaziz Medical City-Jeddah (KAMC-J) between 2014 and 2023 were retrospectively reviewed, and all relevant information including body mass index, medical and surgical history, and postoperative outcomes were obtained. Results A total of 20 cases were included in the present study, sixteen (80%) of which were females and four (20%) were males. The mean age of participants was 42.59±13.9 years. Nine cases (45%) were spontaneous CSF rhinorrhea and 11 (55%) were traumatic; within the traumatic group, six cases (54%) were iatrogenic either following previous neurosurgery or functional endoscopic sinus surgery, while the remaining five cases were related to motor vehicle accidents. The mean body mass index for the spontaneous CSF leak was 32 Kg/m2, and 33 Kg/m2 for the traumatic leaks, no statistically significant difference was noted. The cribriform plate was the most common site of leakage (65%). A multilayer surgical technique using facia lata graft with nasoseptal flap was the most common choice for reconstruction with a first-attempt success rate approximating 90%. A recurrence was observed in two patients only. No major complications were reported. The average length of stay was nine days. Conclusion The endoscopic endonasal repair of CSF leak is a safe and reliable procedure and is associated with high success rates and low risk of complications. Therefore, it should be preferred as a first-line treatment for CSF rhinorrhea.

Keywords: cerebrospinal fluid rhinorrhea; csf rhinorrhoea; endoscopic csf leak repair; spontaneous cerebrospinal fluid rhinorrhea; traumatic csf leak.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Distribution of cerebrospinal fluid (CSF) leak sites
Figure 2
Figure 2. Distribution of cerebrospinal fluid (CSF) leak sites according to etiology of CSF leak
Figure 3
Figure 3. A description of the relationship between body mass index and cerebrospinal fluid (CSF) leak etiology
See this image and copyright information in PMC

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