Cerebrospinal Fluid Rhinorrhea – Diagnostic Metodes Review and Clinical Cases Demonstration

Abstract

Introduction: Cerebrospinal fluid rhinorrhea means a cerebrospinal fluid leakage from subarachnoid space into paranasal sinuses and from there into the nasal cavity. The exact localization of the rhinobasis defect causing cerebrospinal leak is always a serious problem and the exact choice of the diagnostic method lays in the base of the surgical success. Aim: Using our experience and literature data, to review cerebrospinal fluid rhinorrhea diagnostic methods and their practical importance. Material and methods: For the period 2000 - 2015 year in the ENT department of UMHAT Plovdiv 18 cerebrospinal fluid rhinorrhea cases have been diagnosed. Most of them were spontaneous or caused by neoplasm development. The correlation men to women was 5:13. In all cases several diagnostic methods were used – glucose oxidase test, high-resolution computed tomography (CT), in one case intrathecal fluorescein was used followed by endoscopic endonasal verification. Four of all 18 cerebrospinal fluid rhinorrhea cases arise with symptoms of rhinogenic meningitis. All patients underwent endonasal surgical treatment – dura matter closure. Results: In 14 cases there was successful dura matter closure after the first surgery. No fluid leakage was detected. The endoscopic exam showed definitely closure of the defect. As for the rest cases, in 3 of them the cerebrospinal fluid rhinorrhea persisted postoperatively and in one case there was recurrence after one year. After another endoscopic surgery an definite leakage stop was achieved in all cases. Conclusions: Modern diagnostic tests and endoscopic endonasal methods for closure with alogenic material permit relatively sure prove and localization of the rhinobasis defects and its definitive treatment, with low mortality and complications rate.