Spontaneous Cerebrospinal Fluid Rhinorrhea Research Articles

A case of rhino-orbital cerebral mucormycosis presenting with spontaneous cerebrospinal fluid rhinorrhoea

Rhino orbital cerebral mucormycosis has increased in the recent second wave of post COVID 19 illness, mainly in tropical countries like India.

Spontaneous Cerebrospinal Fluid Rhinorrhea and Otorrhea: A Case Report and Literature Review.

Spontaneous cerebrospinal fluid (CSF) leak is a condition that commonly presents with unilateral watery drainage from the nose or ear, tinnitus, and stuffy ears or hearing loss. Spontaneous CSF rhinorrhea and otorrhea together are rare. A 64-year-old woman presented at our department with complaints of clear watery rhinorrhea and hearing loss on the right side persisting for 10months. Imaging and surgery were used to diagnose the condition. Through surgical treatment, she was eventually cured. Review of the literature has shown that patients with both nasal and aural CSF leaks are rare. When a patient presents with both unilateral watery drainage from both the nose and ear, a diagnosis of CSF rhinorrhea and otorrhea should be considered. This case report will benefit clinicians by providing more information to assist with diagnosing the disease.

Spontaneous cerebrospinal fluid rhinorrhoea during pregnancy-case report and review of literature

Abstract Objectives Rhinoliquorrhea is a condition where cerebrospinal fluid (CSF) leaks due to a liquor fistula formation of traumatic or non-traumatic origin. It can be associated with increased intracranial pressure often due to idiopathic intracranial hypertension (IIH), typically found in young and obese female patients. Case presentation A 27-year-old woman, 2 gravida, 1 para, presented with clear rhinorrhoea. After a beta-trace-protein test the diagnosis of CSF leakage was determined. The woman had had a traumatic car accident in 2018 but had never developed clear rhinorrhoea, especially not in her first pregnancy after the accident. Due to stable condition of the mother further diagnostics were postponed until after the birth. An elective caesarean section was performed in 40 + 0 weeks of gestations. The structural bone defect in the posterior wall of the sphenoid sinus was surgically repaired by defect coverage postpartum. Conclusions Nasal CSF leakage in pregnancy has previously been described in four other case reports with mostly traumatic etiology. Additionally, IIH is an important diagnosis to keep in mind. So far there are no guidelines or evidence-based recommendations regarding to optimal fistula treatment of pregnant women available. For therapy a prophylactic antibiotic therapy, surgical reconstruction with sealing and a wait-and-see strategy should be considered and discussed.

Leaking Skull Base - Imaging of Two Cases of Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhea Involving Sphenoid Sinus.

Leaking Skull Base - Imaging of Two Cases of Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhea Involving Sphenoid Sinus.

A conservative surgical strategy for spontaneous cerebrospinal fluid leakage: a rare case report

A 59-year-old male with no history of trauma or surgery presented with clear rhinorrhea occurring when he bent his head forward. A CT scan revealed localized fluid accumulation and a lateral wall defect involving the left sphenoid sinus. Using the transpterygoid approach, we widened the anterior wall of the sphenoid sinus inferolaterally to expose the lesion as much as possible. Reconstruction involved placing an interposition graft between the dura and the bony defect using the underlay technique, followed by free mucosal grafting. Histopathological examination revealed neuroglial cells, confirming the diagnosis of spontaneous cerebrospinal fluid rhinorrhea due to a meningoencephalocele.

A CASE SERIES ON MANAGEMENT OF SPONTANEOUS CEREBROSPINAL FLUID RHINORRHEA

Introduction: Cerebrospinal fluid (CSF) rhinorrhea is defined as leakage of cerebrospinal fluid that occurs from a direct communication between the CSF-containing subarachnoid space and the paranasal sinuses. Non traumatic or spontaneous CSF rhinorrhea is very rare and reported to have occurred in only 4% of the CSF leak cases. Materials and Methods: A retrospective hospital-based study was conducted in a tertiary care centre on seven cases of spontaneous CSF Rhinorrhea. Observation and Results: Among seven cases, five patients were of age less than 45 years and two patients were more than 45 years old. All subjects were females and were diagnosed with spontaneous CSF rhinorrhea. CT paranasal sinuses and CT Cisternogram were the most common imaging modalities used for diagnosis in all patients. All patients underwent Transnasal endoscopic repair of CSF rhinorrhea. Conclusion: Transnasal endoscopic repair of the defect gives a successful outcome following failure of the conservative management in spontaneous CSF rhinorrhea.

Surgical Management of Spontaneous Cerebrospinal Fluid Rhinorrhea

Cave, Taylor MD; Marino, Michael J. MD; Lal, Devyani MD; Soler, Zachary M. MD, MSc; Bendok, Bernard R. MD; Miglani, Amar MD Author Information

Surgical Management of Spontaneous Cerebrospinal Fluid Rhinorrhea

Surgical Management of Spontaneous Cerebrospinal Fluid Rhinorrhea

Endoscopic Repair of CSF Rhinorrhea: Our Experience at a Tertiary Centre.

Spontaneous or post-traumatic CSF (cerebrospinal-fluid) rhinorrhea occurs when there is a skull-base defect. In our study, we tried endoscopic approach, exclusively as surgical modality. To study feasibility of trans-nasal endoscopic approach for repair of skull-base defects and success rates at each anatomical subsite, with complications. Patients, who underwent endoscopic repair of CSF rhinorrhea between 2016 and 2019 were recruited into study. Details of investigative work-up, aetiology, surgery done, site of leak, number of surgical procedures done, post-operative complications and their management, success rate for each anatomical sub-site, was retrieved retrospectively and analyzed. All patients were initially managed with conservative measures before taking up for surgery. Eighteen-patients (male-11, female-7, mean age-40.3years) with CSF rhinorrhea {spontaneous-5(27.7%), traumatic-13(62.3%)} were found. Sites of leak were cribriform-plate (CP), fovea-ethmoidalis (FE) and posterior-table of frontal-sinus (FS) in 8(44.4%), 5(27.7%) and 5(27.7%) respectively. Twelve (66.6%) patients had no postoperative complications. No patients with defects in CP had post-operative complication. Two (11.1%) patients with FS defect had meningitis, one (5.5%) patient with FS defect developed pneumocephalus. One (5.5%) patient developed frontal sinusitis at end of 4-months. Two (11.1%) patients, each with defects in FE and FS needed a revision repair on postoperative day 0 and 90-till date, none of the patients have any delayed procedure related complications or recurrences. Endoscopic repair of CSF leaks is the norm of the current day due to its minimally invasive nature. However, endoscopic repair of leaks through the frontal sinus were challenging and was associated with a high rate of complications.

SNOT-22 Quality of Life Scores Improve After Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea.

Patients with spontaneous cerebrospinal fluid (CSF) rhinorrhea can experience significant sinonasal symptom burden, leading to poor quality of life (QOL). The objective of this study was to investigate sinonasal outcome test-22 (SNOT-22) scores in patients undergoing endoscopic endonasal surgery for spontaneous CSF rhinorrhea and compare them to patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis without nasal polyps (CRSsNP). A multi-institutional retrospective review of patients with spontaneous CSF rhinorrhea and CRSsNP was performed. Pre-surgery and post-surgery SNOT-22 scores and domains were compared within each group. Improvements in SNOT-22 scores after surgery were compared between the groups. Ninety-one patients were in the CSF rhinorrhea group and 105 patients were in the CRSsNP group. Within each group, surgery significantly improved total SNOT-22 scores, domain scores, and most of the individual symptoms. Comparing the 2 groups revealed similar improvements in total SNOT-22 scores (P = .244). The CSF rhinorrhea group improved more in runny nose (P < .001), postnasal discharge (P < .001), wake up at night (P = .024), and embarrassed (P = .002). The CRSsNP group improved more in sneezing (P = .027), nasal blockage (P < .001), decreased sense of smell/taste (P = .011), thick nasal discharge (P < .001), facial pain/pressure (P = .008), and the ear/facial domain (P = .010). Patients with spontaneous CSF rhinorrhea experience significant symptom burden. Those who undergo CSF leak repair should experience significant improvement in QOL similar to patients who undergo ESS for CRSsNP as measured by SNOT-22.

Endoscopic cerebrospinal fluid leak repair combined with thecoperitoneal shunting for spontaneous cerebrospinal fluid rhinorrhea: MERF experience

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Spontaneous cerebrospinal fluid (CSF) rhinorrhoea is encountered as a diagnosis of exclusion in clinical practice once all other aetiologies have been meticulously ruled out and can mostly present from preformed pathways due to benign intracranial hypertension (BIH) over time. Such leaks need to be clearly located for planning appropriate repair along with adequate control of CSF pressure to avoid recurrence. Thus, the aim of our study was to review the efficacy and outcomes of a combined endoscopic multilayered repair along with simultaneous theco-peritoneal shunting (TPS) for patients with spontaneous CSF rhinorrhoea in the background of BIH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Retrospective observational study analyzing the clinical presentations, surgical techniques and the immediate / long term outcomes of this combined approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The&lt;strong&gt; &lt;/strong&gt;46 patients who had endoscopic CSF repair with TPS done between 2008-2019 were reviewed. The mean opening CSF pressure in these cases were &amp;gt;25 cm H&lt;sub&gt;2&lt;/sub&gt;O. The commonest site of leak was from cribriform plate followed by fovea ethmoidalis. Multilayered closure was done with autologous grafts along with TPS simultaneously. The 92% were successful, 6% had shunt problems needing revision shunts and 2% also needed revision endoscopic repair. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Overall outcomes shows that the combined approach was safe and effective in arresting the CSF leak in 98% patients. Therefore, the rationale for a combined approach for the management of spontaneous CSF leaks in the background of BIH stands proven based on our Institutional experience.&lt;/p&gt;

Postoperative Cerebrospinal Fluid Rhinorrhea with Purulent Meningitis in a Child: A Case Report

Cerebrospinal fluid rhinorrhea is a disruption of the hypopituitarism barrier that causes cerebrospinal fluid to flow through the arachnoid, dura mater and skull base into the nasal cavity or sinuses and out of the nostrils or nasopharynx exit. In patients with nasal leakage of cerebrospinal fluid, a We report a case of a boy who had intermittent and regular fever after surgery, which was treated with We report a case of a boy who had intermittent and regular fever after surgery, which was treated with oral medication but was not effective, accompanied by headache and diplopia, which resolved when the cerebrospinal fluid flowed through the nose. Clinical practice, we often see febrile children and often report spontaneous or post-traumatic cerebrospinal fluid rhinorrhoea, which can allow As a paediatrician, the clinical signs are often atypical and nowadays children often suffer from allergic rhinorrhoea, which can be caused by the presence of bacteria, viruses or atypical pathogens to retrograde into the skull and cause meningitis. Nowadays children often suffer from allergic rhinitis with similar features to cerebrospinal fluid rhinorrhoea, which requires prompt clinical The clinical signs are often atypical and nowadays children often suffer from allergic rhinitis with similar features to cerebrospinal fluid rhinorrhoea, which requires prompt clinical judgment and treatment.&#x0D; Our case shows that in children with regular fever and a regular flow of clear fluid from the nasal cavity, we need to be alert for this disease and differentiate it from diseases such as allergic rhinitis.

Endonasal endoscopic management of spontaneous cerebrospinal fluid rhinorrhoea: The Birmingham UK experience.

Spontaneous cerebrospinal fluid (CSF) leaks (SCSFL) occur in the absence of trauma, surgery, or underlying intracranial pathology. They represent a significant healthcare burden on patients with complications such as meningitis. We present our experience of SCSFL repair via the endonasal endoscopic approach. All patients who underwent CSF fistula repair at a tertiary UK hospital, between 1st January 2012 to 31st December 2019, were identified and had their case notes analyzed retrospectively. There were 33 patients included consisting of 27 (81.8%) females, with age range from 31 to 81 years (mean 55.2). Mean body mass index (BMI) was 35.2kg/m2 , with 32 (97.0%) patients overweight (BMI >25). All patients presented with intermittent watery rhinorrhoea and had a positive biochemical analysis. Computed tomography (CT) and/or magnetic resonance imaging (MRI) identified leak sites in 29 patients (87.9%). The most common intraoperative defect site was the cribriform plate (42.4%). A variety of closing techniques were used including onlay grafts (72.7%), tissue glue (87.9%), nasoseptal flaps (63.6%), mucosal free grafts (21.2%), fat grafts (21.2%), and additional support materials (87.9%). Nasal packing was used in all patients. The average length of stay was 1.6 days. Postoperative complications occurred in two patients (6.1%) (meningitis, epistaxis). Overall, there was a successful primary repair in 32 (97.0%) patients with most cases employing a multilayered reconstruction method (78.8%). Our results demonstrate excellent success rates with the endoscopic endonasal approach to SCSFL. This adds to the literature by demonstrating a detailed analysis of the experience in SCSFL management in one of the largest UK centres.

Individual SNOT-22 Items Aid in Differentiating Between Spontaneous Cerebrospinal Fluid Rhinorrhea and Chronic Rhinosinusitis Without Nasal Polyps.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)-22 could suggest a diagnosis of spontaneous CSF rhinorrhea versus chronic rhinosinusitis without nasal polyps (CRSsNP). A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared. One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (P < .001) and was more likely to designate this symptom as most important (P < .001). The CRSsNP group scored significantly higher in nasal blockage (P < .001), thick nasal discharge (P < .001), facial pain/pressure (P < .001), and in the ear/facial (P < .001) and rhinologic (P = .003) domains. Multivariable logistic regression revealed that runny nose (P < .001) was most predictive of spontaneous CSF rhinorrhea while nasal blockage (P < .001), thick nasal discharge (P < .001), and facial pain/pressure (P = .001) were predictive of CRSsNP after adjusting for relevant confounders. No significant difference was observed in total SNOT-22 scores between groups (P = .676). Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.

Non Spontaneous Cerebrospinal Fluid Rhinorrhoea and Subsequent Bacterial Meningitis: A Case Report

Cerebrospinal Fluid (CSF) protects brain and maintains intracranial pressure which is secreted by choroid plexus. After severe Craniomaxillofacial (CMF) trauma, disruption of meningeal structure leads to CSF leak. About 80-90% of CSF leak in adults is due to head injuries. CSF rhinorrhoea can be classified into spontaneous and non spontaneous. Meningitis is seen in 19% of persistent CSF leakage with 10% of mortality due to delayed and longer duration of the CSF leakage. Post-traumatic CSF leaks are commonly seen in 1-3% of adults among all head injuries. Traumatic CSF leak is reported to be approximately 10-30% of the skull base fractures in adults. Common pathogens of meningitis are Haemophilus influenzae (H. influenzae) and Streptococcus pneumoniae (S. pneumoniae). Present case was of non spontaneous CSF rhinorrhoea and subsequent bacterial meningitis in a 33-year-old male patient, with fever and chills, headache, vomiting, neck stiffness. Kernig sign’s was present. Patient had past history of road traffic accident and found to have CMF injury. Neurosurgery opinion was sought and found to be persistent CSF rhinorrhoea. Haematological and chemical analysis of cerebrospinal fluid was abnormal. CSF and blood sample sent for culture and sensitivity. H. influenzae grown in both culture. H. influenzae is an uncommon cause of adult bacterial meningitis.

MR findings suggestive of idiopathic intracranial hypertension in 117 patients with spontaneous cerebrospinal fluid rhinorrhea.

The purpose of this study is to document the prevalence of MR findings suggestive of idiopathic intracranial hypertension (IIH) in patients undergoing endoscopic repair of spontaneous CSF rhinorrhea (SCSFR). In a retrospective study, MR images of 117 consecutive patients who had undergone endoscopic repair of SCSFR were evaluated for features suggestive of IIH (empty sella, widened optic nerve sheath, tortuous optic nerve, flattened posterior globe, and enlarged Meckel's cave). Pituitary height was used to diagnose partial and complete empty sella. MR images were independently evaluated by two of the authors without knowledge of the clinical findings. Consensus method was used to resolve differences between the two evaluators. Empty or partially empty sella was diagnosed in the MR of 105 (89.7%) patients. In 38/105 (36.2%) patients with empty/partial empty sella, no additional MR findings were present. In 43/105 (41%) patients, one or more of the MR features with high specificity for diagnosis of IIH (flattened posterior globe and enlarged Meckel's cave) were seen. In the other 24 (22.9%) additional MR findings, less specific for IIH (widened optic nerve sheath, tortuous optic nerve) were noted. Papilledema was seen in 11 of 60 (18.3%) patients who underwent funduscopic examination. All patients with papilledema had empty/partial empty sella, and 9/11 (81.8%) had an additional MR finding suggestive of IIH. The majority of patients with SCSFR have MR imaging features of IIH. These imaging features should be a major component of previously published modified diagnostic criteria for IIH in patients with SCSFR.

Post-traumatic cerebrospinal fluid rhinorrhea and Transcranial approach surgical outcomes.

Objective: To assess the outcomes of the transcranial approach in traumatic cerebrospinal fluid rhinorrhea. Study Design: Descriptive study. Setting: J.P.M.C, Karachi. Period: 15-1-2017 to 17-7- 2019. Material &amp; Method: Total of 57 patient were included. Including criteria were patient with a history of trauma, fall, assault, and delayed onset, however, patients presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, brain abscess, brain space-occupying lesion, skull base surgery operated elsewhere were excluded. fasia lata, Pericranial flaps were used for the surgical repair. Data were analyzed on SPSS version 22.0. Result: Patients gone through the surgical approach having intradural repair in all patients, 25 (43.85%) patients with fasia lata graft while pericranium in 32 (56.1%) and the defect was filled with small bone pieces. In 38(66.6%) unilateral sub frontal approach was done while in 19 patients (33.3 %%) bicoronal craniotomy was carried out. All patient had dura defected, 37 patients (64.9%) had a fractured cribriform plate, 9 (15%) patient had fovea ethmoidal fracture. 30(52.63%) had right side leak, 20 had left side leak (35%), 7(12.28%) had bilateral from both nasals leakage. No reoperation was done. 93% procedure showed successfully. Conclusions: This method is effective with the low rate of morbidity in patients, it can be preferred for traumatic cerebrospinal fluid (CSF) leaks with the injuries associated with the brain, recurrent leak cases with a success rate of &gt; 93%

Recurrent spontaneous CSF rhinorrhea: combined endo-nasal endoscopic repair with lumbo-peritoneal shunt insertion

BackgroundSpontaneous cerebrospinal fluid (CSF) leaks are associated with high morbidity and recurrence rates. Most cases had increased intracranial pressure (ICP) on presentation. There is still controversy regarding the use of lumbo-peritoneal shunt to prevent its recurrence.AimThis study was conducted to evaluate the impact of lumbo-peritoneal CSF shunt following the initial as well as recurrent repair of spontaneous CSF leaks to avoid recurrence.MethodsA retrospective cohort study reviewed patients with recurrent spontaneous CSF leaks over a 4-year period. All patients had increased ICP and were subjected to endoscopic repair and lumbo-peritoneal shunt procedure.ResultsEighteen patients were included in this study. Most patients were obese (BMI = 33.6 ± 1.8 kg/m2) women (88.9%), with sleep apnea syndrome (77.8%). All patients presented with headache and visual complaints. Meningitis was recorded in two patients (11.1%). The most common sites of leakage were the cribriform (66.7%), followed by both cribriform and ethmoidal (16.7%), sphenoid (11.1%), and ethmoidal (5.6%) bones. The mean defect size was 5.1 ± 1.1 mm. About one third of cases had multiple defects. Encephalocele and meningocele were encountered in 61.1% and 66.7% of cases, respectively. The mean preoperative CSF pressure was 36.5 ± 1.7 mm H2O. Lumbo-peritoneal shunt was inserted for all our patients. The failure rate of repair was 11.1%.ConclusionSuccess rate is higher in patients with spontaneous CSF leaks and CSF hypertension treated by lumbo-peritoneal shunt. Future prospective studies with larger sample sizes should confirm the efficacy and safety of this management plan.

Do All Notochordal Lesions Require Proton Beam Radiotherapy? A Proposed Reclassification of Ecchordosis Physaliphora as Benign Notochord Cell Tumor.

Objectives Ecchordosis physaliphora (EP) is a benign notochord lesion of the clivus arising from the same cell line as chordoma, its malignant counterpart. Although usually asymptomatic, it can cause spontaneous cerebrospinal fluid (CSF) rhinorrhea. Benign notochordal cell tumor (BNCT) is considered another indolent, benign variant of chordoma. Although aggressive forms of chordoma require maximal safe resection followed by proton beam radiotherapy, BNCT and EP can be managed with close imaging surveillance without resection or radiotherapy. However, while BNCT and EP can be distinguished from more aggressive forms of chordoma, differentiating the two is challenging as they are radiologically and histopathologically identical. This case series aims to characterize the clinicopathological features of EP and to propose classifying EP and BNCT together for the purposes of clinical management. Design Case series. Setting Tertiary referral center, United Kingdom. Participants Patients with suspected EP from 2015 to 2019. Main Outcome Measures Diagnosis of EP. Results Seven patients with radiological suspicion of EP were identified. Five presented with CSF rhinorrhea and two were asymptomatic. Magnetic resonance imaging features consistently showed T1-hypointense, T2-hyperintense nonenhancing lesions. Diagnosis was made on biopsy for patients requiring repair and radiologically where no surgery was indicated. The histological features of EP included physaliphorous cells of notochordal origin (positive epithelial membrane antigen, S100, CD10, and/or MNF116) without mitotic activity. Conclusion EP is indistinguishable from BNCT. Both demonstrate markers of notochord cell lines without malignant features. Their management is also identical. We therefore propose grouping EP with BNCT. Close imaging surveillance is required for both as progression to chordoma remains an unquantified risk.

Analysis of correlation between the pneumatization degree of paranasal sinuses and skull base and spontaneous cerebrospinal fluid rhinorrhea

Objective:To investigate the relationship between the pneumatization degree of paranasal sinuses and skull base and the incidence of spontaneous cerebrospinal fluid rhinorrhea （SCSFR）. Methods:Date of 107 patients with SCSFR were reviewed retrospectively. Using CT scans, investigator evaluated the pneumatization degree of paranasal sinuses and skull base, and compared classifications of various imaging characteristics between SCSFR group（case group） and nasal septum deviation group（control group）, including frontal cells, Onodi cell, lateral recess of sphenoid sinus （LRSS）, pneumatization of anterior clinoid process and pneumatization of posterior clinoid process. Results:One hundred and eight fistulas are found among 107 cases. The most common site of the fistulas is found in ethmoid sinus （38.89%）, followed by olfactory cleft（37.04%）, sphenoid sinus （21.30%） and frontal sinus （2.77%）.The incidence of Onodi cell was significantly different between case and control group（χ²=4.755, P<0.05）, and the classification of Onodi cell has a linear effect on the occurrence of SCSFR （Z=3.345, P<0.05）, which suggests the increasing level of Onodi cell can increase the probability in occurrence of SCSFR. The incidence of type Ⅲ LRSS in the case group is significantly higher than in the control group（χ²=18.725, P<0.05）,a linear correlation is found between the classification of LRSS and the incidence of SCSFR （Z=3.578, P<0.05）.There was no significant difference in the incidence of frontal cells between the two groups（χ²=0.672, P>0.05）, nor was there a linear relationship between the classification of frontal cells and the incidence of SCSFR （Z=0.503, P>0.05）. Pneumatization of anterior clinoid process and posterior clinoid process were no significant difference between case and control （P>0.05）,nor were there linear relationships between their classifications and SCSFR （P>0.05）. Conclusion:The most common site of SCSFR is ethmoid sinus, followed by olfactory cleft,the hyperpneumatization of the LRSS and Onodi cell are closely related to its pathogenesis.