Abstract
Background:Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a rare entity. The accurate preoperative localization of the leak point is essential for planning surgical treatment, but is sometimes difficult. To localize the leak point, magnetic resonance cisternography (MRC) is the method of choice, but its effectiveness remains unclear.Case Description:A 34-year-old mildly obese female experienced spontaneous CSF rhinorrhea after an attack of bronchial asthma. High-resolution computed tomography (CT) failed to reveal the leak point, while MRC demonstrated an arachnoid herniation at the olfactory cleft. The patient underwent endoscopic endonasal repair of the CSF leak with success. There has been no recurrence of CSF rhinorrhea for 14 months after surgery followed by the administration of acetazolamide.Conclusion:We report a rare case of spontaneous CSF rhinorrhea associated with benign intracranial hypertension, in which the leak point was successfully detected by MRC. The CSF leak was completely repaired by minimally invasive endoscopic endonasal surgery. MRC may be a reliable method for detecting CSF leak points.
Highlights
Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a rare entity
The term spontaneous cerebrospinal fluid (CSF) rhinorrhea has been applied to describe the nasal discharge of CSF unrelated to trauma, surgery, malformation, or tumor.[12]
It is related to elevated intracranial pressure (ICP) and it has been suggested that this high pressure might be the direct cause of the leak.[3,16,18]
Summary
A case of spontaneous cerebrospinal fluid rhinorrhea: Accurate detection of the leak point by magnetic resonance cisternography. Departments of Neurosurgery, and 1Otolaryngology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. This article may be cited as: Matsubara T,Akutsu H,Tanaka S,Yamamoto T, Ishikawa E, Matsumura A.A case of spontaneous cerebrospinal fluid rhinorrhea:Accurate detection of the leak point by magnetic resonance cisternography. Available FREE in open access from: http://www.surgicalneurologyint.com/text.asp?2014/5/1/54/131105
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