Endoscopic diagnosis and management of cerebrospinal fluid rhinorrhea

Abstract

Cerebrospinal fluid (CSF) rhinorrhea may have many caus es, but it always represents a risk of meningitis or brain abscess. For this reason, CSF leaks should be sought when trauma occurs to the head or when rhinor­ rhea is present, and any CSF leak must be managed. CSF leaks can occur from trauma secondary to head injuries, base of skull fractures, craniotomy, and paranasal sinus surgery. Traumatic CSF rhinorrhea most often occurs through the frontal sinus, cribriform plate, fovea ethmoi­ dalis, sphenoid sinus, or into the middle ear through de­ fects in the middle or posterior fossa . Nontraumatic CSF rhinorrhea can occur with low-pressure flow, as in bony erosion, sellar atrophy, and congenital anomalies. High­ pressure flow may be associated with CSF rhinorrhea in hydrocephalus and intracranial tumors. This article is limited to CSF rhinorrhea, which can be diagnosed and managed successfully by both intracranial and transnasal approaches with nasal endoscopes.l ' This article describes the diagnosis of CSF rhinorrhea and conservative techniques for its management.