Spontaneous "high-pressure cerebrospinal rhinorrhea" due to lesions obstructing flow of cerebrospinal fluid.

Abstract

C EREBROSPINAL fluid (CSF) rhinorrhea resulting from trauma or following cranial surgery is common and well documented. 9,1c,23 Less prevalent causes of CSF leakage are infection of the paranasal sinuses with osteomyelitis of adjacent bone, 32 congenital anomalies of the brain and its investing membranes such as nasal meningoceles or meningoencephaloceles, 21 and destructive neoplastic lesions at the base of the skull. 25 Obstructive rhinorrhea is far less common and has not received wide attention in the surgical or radiological literature. In this variety, the anatomical defect responsible for CSF leakage arises as the direct consequence of long-standing or intermittently severe hydrocephalus due to some lesion interrupting the flow of CSF. High intracranial pressure can cause gradual bony erosion, usually of the cribriform plate, and attenuation of the adjacent investing membranes at the base of the skull. Their eventual disruption leads to escape of cerebrospinal fluid into the nose. Under these circumstances CSF rhinorrhea may occur spontaneously, although in certain instances a trivial head injury apparently may complete the opening in an already thinned-out cribriform plate. This report concerns four patients having rhinorrhea caused by intracranial lesions obstructing CSF flow, a situation we have designated as spontaneous high-pressure CSF Two of these patients had benign circumscribed mass lesions occluding the CSF pathways at the foramen of Monro; removal of these tumors eliminated the rhinorrhea. One patient had obstructive hydrocephalus secondary to a parieto-occipital meningioma. The CSF rhinorrhea abated following tumor removal but ceased entirely only after a secondary repair of the dural de-