Abstract
Introduction: The exact pathophysiology of spontaneous CSF rhinorrhea is not always understood in some patients. Idiopathic intracranial hypertension (IIH) is now recognized as one of the causes of spontaneous CSF leak in the neurosurgical and ENT literature. Our aim was to set a management protocol for such cases according to the same setting intracranial tension (ICT). Methods: We prospectively managed patients with spontaneous CSF rhinorrhea who were admitted to our hospital between 1st of January 2014 and 31st of December 2017 with a prespecified treatment algorithm. Patients with a history of previous cranial or nasal surgery, trauma, skull base congenital malformations were excluded from the study. The patient’s demographics, clinical data, comorbidities, body mass index (BMI), first time or recurrent leakage and duration of the leak were collected. Results: 41 patients, 35 females and 6 males, presented with spontaneous CSF rhinorrhea with a mean BMI of 38 ± 4.16 Kg/m2. The mean pre-operative ICT manometry was 17.2 ± 5.9 cmH2O (range, 10 - 26 cmH2O). 43.9% of the patients were found to have an increased ICT (≥20 cmH2O) and underwent a permanent CSF diversion at the same setting of the endoscopic repair. None of the patients had a recurrence during the follow-up period. Conclusion: The prespecified treatment algorithm with measuring the ICT at the same setting of the endoscopic repair has a better result for control of spontaneous CSF rhinorrhea. This has led to no recurrence and decreased hospital stay.
Highlights
The exact pathophysiology of spontaneous cerebrospinal fluid (CSF) rhinorrhea is not always understood in some patients
The prespecified treatment algorithm with measuring the intracranial tension (ICT) at the same setting of the endoscopic repair has a better result for control of spontaneous CSF rhinorrhea
All patients presented to the neurosurgery and ENT department at Cairo University hospitals between 1st of January 2014 and 31st of December 2017 with spontaneous CSF rhinorrhea were included in the study
Summary
The exact pathophysiology of spontaneous CSF rhinorrhea is not always understood in some patients. Conclusion: The prespecified treatment algorithm with measuring the ICT at the same setting of the endoscopic repair has a better result for control of spontaneous CSF rhinorrhea. This has led to no recurrence and decreased hospital stay. Some of the IIH patients might present only with CSF leak symptoms such as rhinorrhea, low tension headaches, or bacterial meningitis. The typical symptoms of IIH usually start a few weeks to months after the surgical CSF leak repair because of increased intracranial tension (ICT) [11]. These measures may temporarily seal the repair site, but due to a continuous high-pressure gradient, the defect will dehisce which occurs even later than 14 months post-repair [15] [16]
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