cerebrospinal fluid rhinorrhea

Summary

Summary: Discharge of cerebrospinal fluid through the nose. Common etiologies include trauma, neoplasms, and prior surgery, although the condition may occur spontaneously. (Otolaryngol Head Neck Surg 1997 Apr;116(4):442-9)

Top Publications

  1. Suliman S, Gurlek A, Byrne J, Sullivan N, Thanabalasingham G, Cudlip S, et al. Nonsurgical cerebrospinal fluid rhinorrhea in invasive macroprolactinoma: incidence, radiological, and clinicopathological features. J Clin Endocrinol Metab. 2007;92:3829-35 pubmed
    ..Macroprolactinomas (MPRLs) may result in nonsurgical (spontaneous or dopamine agonist induced) cerebrospinal fluid (CSF) rhinorrhea; however, the incidence of and mechanisms underlying this phenomenon are poorly understood...
  2. Arai A, Mizukawa K, Nishihara M, Fujita A, Hosoda K, Kohmura E. Spontaneous cerebrospinal fluid rhinorrhea associated with a far lateral temporal encephalocele--case report. Neurol Med Chir (Tokyo). 2010;50:243-5 pubmed
    ..At 1-year follow up, the CSF rhinorrhea had not recurred. Transcranial multilayered closure of the defect is safe and reliable, particularly for large CSF fistula at the far lateral sphenoid sinus...
  3. Hongmei Y, Zhe W, Jing W, Daokui W, Peicheng C, Yongjie L. Delayed cerebrospinal fluid rhinorrhea after gamma knife surgery in a patient with a growth hormone-secreting adenoma. J Clin Neurosci. 2012;19:900-2 pubmed publisher
    ..The other potential causes may be the original invasiveness of the tumor or delayed radiation damage to the mucous membranes of the skull. Long-term follow-up is required to monitor recurrence of CSF rhinorrhea...
  4. Schaberg M, Anand V, Schwartz T. 10 pearls for safe endoscopic skull base surgery. Otolaryngol Clin North Am. 2010;43:945-54 pubmed publisher
    ..This article presents the 10 most important tenets that have proved useful to the authors regarding postoperative patient management and surgical practice...
  5. Daele J, Goffart Y, Machiels S. Traumatic, iatrogenic, and spontaneous cerebrospinal fluid (CSF) leak: endoscopic repair. B-ENT. 2011;7 Suppl 17:47-60 pubmed
    ..Recent reports in the literature highlight the group of patients with spontaneous idiopathic CSF leak as a group with specific attributes and treatment challenges...
  6. Seth R, Rajasekaran K, Luong A, Benninger M, Batra P. Spontaneous CSF leaks: factors predictive of additional interventions. Laryngoscope. 2010;120:2141-6 pubmed publisher
    ..The study objective was to review management strategy and identify factors associated with need for acetazolamide and/or ventriculoperitoneal shunt (VPS) placement...
  7. Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal. 2007;12:E397-400 pubmed
    ..The timing for surgery and CSF drainage procedures must be decided with great care and with a clear strategy...
  8. Senior B, Jafri K, Benninger M. Safety and efficacy of endoscopic repair of CSF leaks and encephaloceles: a survey of the members of the American Rhinologic Society. Am J Rhinol. 2001;15:21-5 pubmed
    ..Overall, our results confirm that in the hands of the skilled endoscopist, endoscopic management of CSF leaks and encephaloceles is highly efficacious and has a very low incidence of significant complication...
  9. Peltonen E, Sedlmaier B, Brock M, Kombos T. Persistent cerebrospinal fluid rhinorrhea by intrasphenoidal encephalocele. Zentralbl Neurochir. 2008;69:187-90 pubmed publisher
    ..The pathogenesis of this anomaly is analyzed, the clinical findings and the operative treatment are described, and the literature is reviewed...

More Information

Publications62

  1. Welch K, Palmer J. Intraoperative emergencies during endoscopic sinus surgery: CSF leak and orbital hematoma. Otolaryngol Clin North Am. 2008;41:581-96, ix-x pubmed publisher
    ..Intraoperative orbital hematoma is discussed and a stepwise approach to reduce complications is provided...
  2. Martin T, Loehrl T. Endoscopic CSF leak repair. Curr Opin Otolaryngol Head Neck Surg. 2007;15:35-9 pubmed
    ..The purpose of this review is to discuss endoscopic management of cerebrospinal fluid leaks and to highlight recent advances in both outcomes and technique...
  3. Chi J, Sughrue M, Kunwar S, Lawton M. The "yo-yo" technique to prevent cerebrospinal fluid rhinorrhea after anterior clinoidectomy for proximal internal carotid artery aneurysms. Neurosurgery. 2006;59:ONS101-7; discussion ONS101-7 pubmed
    ..We present a technique for repairing this defect and preventing CSF rhinorrhea...
  4. Bernal Sprekelsen M, Alobid I, Mullol J, Trobat F, Tomas Barberan M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology. 2005;43:277-81 pubmed
    ..Closure of the leaks is believed to prevent ascending meningitis, although no report has specifically shown this...
  5. Bikmaz K, Cosar M, Iplikcioglu A, Dinc C, Hatiboglu M. Spontaneous cerebrospinal fluid rhinorrhoea due to temporosphenoidal encephalocele. J Clin Neurosci. 2005;12:827-9 pubmed
    ..Spontaneous CSF rhinorrhoea is only infrequently due to temporal encephalocele. Anteromedial temporosphenoidal encephaloceles are the least common type of temporal encephalocele, with only 12 reported in the literature...
  6. Nishioka H, Haraoka J, Ikeda Y. Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery. Acta Neurochir (Wien). 2005;147:1163-6; discussion 1166 pubmed
    ..Cerebrospinal fluid (CSF) rhinorrhea is a potentially life-threatening complication following transsphenoidal surgery (TSS)...
  7. Carrau R, Snyderman C, Kassam A. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope. 2005;115:205-12 pubmed
    ..Patients at high risk for high-pressure hydrocephalus include those who have had a subarachnoid hemorrhage as a result of trauma (accidental or surgical) or stroke and those with spontaneous CSF leaks...
  8. Paludetti G, Sergi B, Rigante M, Campioni P, Galli J. New techniques and technology to repair cerebrospinal fluid rhinorrhea. Acta Otorhinolaryngol Ital. 2004;24:130-6 pubmed
    b>Cerebrospinal fluid rhinorrhea occurs as a result of abnormal communication between the subarachnoid space and the pneumatized portion of the skull base, the paranasal sinuses and the middle ear...
  9. Mirza S, Saeed S, Ramsden R. Extensive tension pneumocephalus complicating continuous lumbar CSF drainage for the management of CSF rhinorrhoea. ORL J Otorhinolaryngol Relat Spec. 2003;65:215-8 pubmed
    ..The prevention and management of pneumocephalus secondary to continuous lumbar CSF drainage is briefly reviewed...
  10. Kubo S, Inui T, Hasegawa H, Yoshimine T. Repair of intractable cerebrospinal fluid rhinorrhea with mucosal flaps and recombinant human basic fibroblast growth factor: technical case report. Neurosurgery. 2005;56:E627; discussion E627 pubmed
  11. Tabaee A, Kassenoff T, Kacker A, Anand V. The efficacy of computer assisted surgery in the endoscopic management of cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg. 2005;133:936-43 pubmed
    ..To determine the outcome of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea with and without computer assisted surgery...
  12. Onerci T, Ayhan K, Ogretmenoglu O. Two consecutive cases of cerebrospinal fluid rhinorrhea after septoplasty operation. Am J Otolaryngol. 2004;25:354-6 pubmed
    ..Prevention of the CSF fistula in septoplasty is more important than its treatment. Realizing the anatomic variations and gentle manipulation at the ethmoid roof is essential...
  13. Telera S, Conte A, Cristalli G, Occhipinti E, Pompili A. Spontaneous cerebrospinal fluid rhinorrhea as the presenting symptom of sellar pathologies: three demonstrative cases. Neurosurg Rev. 2007;30:78-82; discussion 82 pubmed
    ..The present paper reports three unusual cases of sellar pathologies revealed by rhinorrhea as the first symptom discussing controversial issues on pathogenesis, complications and current management of this kind of fistula...
  14. Lindstrom D, Toohill R, Loehrl T, Smith T. Management of cerebrospinal fluid rhinorrhea: the Medical College of Wisconsin experience. Laryngoscope. 2004;114:969-74 pubmed
    ..The purpose of this comprehensive retrospective study is to assess issues related to the management of skull base defects associated with CSF rhinorrhea involving the nose and paranasal sinuses...
  15. Castelnuovo P, Mauri S, Locatelli D, Emanuelli E, Delù G, Giulio G. Endoscopic repair of cerebrospinal fluid rhinorrhea: learning from our failures. Am J Rhinol. 2001;15:333-42 pubmed
    ..The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures...
  16. Petereit H, Bachmann G, Nekic M, Althaus H, Pukrop R. A new nephelometric assay for beta-trace protein (prostaglandin D synthase) as an indicator of liquorrhoea. J Neurol Neurosurg Psychiatry. 2001;71:347-51 pubmed
    ..To determine the sensitivity and specificity of a nephelometric beta-trace protein assay for the diagnosis of liquorrhoea...
  17. Ellamushi H, Hussein J, Harkness W. Spontaneous cerebrospinal fluid rhinorrhoea and pneumocephalus following temporal lobectomy for epilepsy. Br J Neurosurg. 2000;14:565-7 pubmed
    ..CT revealed marked intraventricular pneumocephalus with breached air cells in the pneumatized lower part of temporal bone. The dural and bony defects repaired successfully with complete resolution of the pneumocephalus...
  18. Woodworth B, Prince A, Chiu A, Cohen N, Schlosser R, Bolger W, et al. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg. 2008;138:715-20 pubmed publisher
    ..To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes...
  19. Kamat A, Bhattacharyya D, Carroll T. Brain sag as a cause of postoperative neurological deterioration following anterior cranial fossa floor repair for post traumatic cerebrospinal fluid rhinorrhoea. Br J Neurosurg. 2007;21:303-6 pubmed
    ..Absence of an initial dramatic response to treatment does not necessarily imply poor outcome in the long term...
  20. Platt M, Parnes S. Management of unexpected cerebrospinal fluid leak during endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg. 2009;17:28-32 pubmed publisher
    ..The purpose of this review is to outline the recent advances in the management of cerebrospinal fluid leaks that occur during endoscopic sinus surgery...
  21. Kerr J, Chu F, Bayles S. Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin North Am. 2005;38:597-611 pubmed
    ..With expanded reconstructive techniques, the ability to handle larger disease processes of the skull base continues to expand...
  22. Kirtane M, Gautham K, Upadhyaya S. Endoscopic CSF rhinorrhea closure: our experience in 267 cases. Otolaryngol Head Neck Surg. 2005;132:208-12 pubmed
    The advances in endoscopic sinus surgery have made it the procedure of choice for treatment of cerebrospinal fluid rhinorrhea (CSFR). To analyze the efficacy of endoscopic closure of CSFR was the objective of the present study.
  23. Lee T, Huang C, Chuang C, Huang S. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience. Laryngoscope. 2004;114:1475-81 pubmed
    ..This study determined the effectiveness of endoscopic repair of CSF leaks and interpreted the indications of the lumbar drain...
  24. Schlosser R, Wilensky E, Grady M, Bolger W. Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks. Am J Rhinol. 2003;17:191-5 pubmed
    ..We present clinical and radiographic evidence that indicates elevated ICP in this group. In addition, we review the pathophysiology and unique management issues in caring for patients with spontaneous CSF leak...
  25. Schievink W. Novel neuroimaging modalities in the evaluation of spontaneous cerebrospinal fluid leaks. Curr Neurol Neurosci Rep. 2013;13:358 pubmed publisher
    ..Some patients with spontaneous intracranial hypotension verified by intracranial MRI are never found to have a spinal CSF leak using current techniques...
  26. Baghdadi Y, Larson A, McIntosh A, Shaughnessy W, Dekutoski M, Stans A. Complications of pedicle screws in children 10 years or younger: a case control study. Spine (Phila Pa 1976). 2013;38:E386-93 pubmed publisher
    ..Case control study...
  27. Moe K, Bergeron C, Ellenbogen R. Transorbital neuroendoscopic surgery. Neurosurgery. 2010;67:ons16-28 pubmed publisher
    ..TONES approaches allow simultaneous coplanar visualization and working space above and below the skull base...
  28. Tröbs R, Barenberg K, Hemminghaus M, Günther M, Neid M. Herniation of the brain after conservative treatment of a large congenital skull defect in an infant with Adams-Oliver syndrome. J Pediatr Surg. 2010;45:2064-7 pubmed publisher
    ..This case report highlights the potential serious risks of nonsurgical management of largely extended congenital skull defects...
  29. Caballero N, Bhalla V, Stankiewicz J, Welch K. Effect of lumbar drain placement on recurrence of cerebrospinal rhinorrhea after endoscopic repair. Int Forum Allergy Rhinol. 2012;2:222-6 pubmed publisher
    ..Lumbar drain (LD) use in the management of cerebrospinal fluid (CSF) rhinorrhea remains controversial. We analyzed the relationship between LD placement and CSF leak recurrence after endoscopic repair...
  30. Garcia Navarro V, Anand V, Schwartz T. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg. 2013;80:563-8 pubmed publisher
    ..To assess long-term efficacy of the gasket seal, a method for watertight closure of the cranial base using autologous fascia lata held in place by a rigid buttress, in a large case series...
  31. Liu Y, Liu Y, Hua C. [Analysis of postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation]. Zhongguo Gu Shang. 2013;26:201-4 pubmed
    ..To explore the postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation in treating cervical canal stenosis...
  32. Yamada S, Yasui K, Hasegawa Y. [Hearing loss with positional changes due to spontaneous intracranial hypotension improved with treatment; a case report]. Rinsho Shinkeigaku. 2013;53:50-3 pubmed
    ..In conclusion, non-invasive examinations with audiogram in the supine and sitting positions could be useful in the diagnosis of SIH and the evaluation of therapeutic efficacy of hearing loss...
  33. Malik M, Aberle J, Flitsch J. CSF fistulas after transsphenoidal pituitary surgery--a solved problem?. J Neurol Surg A Cent Eur Neurosurg. 2012;73:275-80 pubmed publisher
    ..The goal of this article is to focus on cerebrospinal fluid (CSF) fistulas after transsphenoidal surgery and discuss possible risk factors and treatment options, including less common procedures in persistent CSF fistulas...
  34. Bleier B, Palmer J. Cranial-base repair using endoscopic laser welding. Otolaryngol Clin North Am. 2009;42:901-6, xi pubmed publisher
    ..Laser welding is a novel technology that can be performed endoscopically and offers the potential of producing instantaneous, watertight repairs using a chromophore-doped biologic solder...
  35. Das P, Balasubramanian D. External frontal sinusotomy and endoscopic repair of cerebrospinal fluid fistula in the posterior wall: preliminary report of a new technique. J Laryngol Otol. 2011;125:802-6 pubmed publisher
    ..We present a new technique of endoscopic repair of frontal sinus posterior wall defects, via access holes drilled in the anterior wall of the frontal sinus...
  36. Stieglitz L, Giordano M, Gerganov V, Samii A, Samii M, Lüdemann W. How obliteration of petrosal air cells by vestibular schwannoma influences the risk of postoperative CSF fistula. Clin Neurol Neurosurg. 2011;113:746-51 pubmed publisher
    ..For postoperative CSF-fistula prevention a better understanding of its origins and risk factors is necessary. To identify the role of the tumor growth for the risk to develop CSF-fistula we performed a retrospective analysis...
  37. Ma H, Sen P, Stein E, Freeman L. Rapid spontaneous cerebrospinal fluid leak detected in the gastrointestinal tract. Clin Nucl Med. 2014;39:198-9 pubmed publisher
    ..We present a spontaneous CSF fluid leak that was detected when scintigraphic activity appeared first in the gastrointestinal tract. ..
  38. Porter R, LaRouere M, Kartush J, Bojrab D, Pieper D. Improved facial nerve outcomes using an evolving treatment method for large acoustic neuromas. Otol Neurotol. 2013;34:304-10 pubmed
    ..To describe a successful paradigm for the treatment of large acoustic neuromas (vestibular schwannomas)...
  39. Castelnuovo P, Dallan I, Battaglia P, Bignami M. Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol. 2010;267:649-63 pubmed publisher
    ..From now onwards, frameless neuronavigation, modular approaches, intraoperative imaging systems and robotic surgery are and will be an increasingly important part of endonasal surgery, and they will be overtaken by further evolution...
  40. Eloy J, Kalyoussef E, Choudhry O, Baredes S, Gandhi C, Govindaraj S, et al. Salvage endoscopic nasoseptal flap repair of persistent cerebrospinal fluid leak after open skull base surgery. Am J Otolaryngol. 2012;33:735-40 pubmed publisher
    ..To our knowledge, use of the PNSF in this setting has not been previously described in the literature...
  41. Ozturk K, Duran M, Arbag H, Keles B, Kara M, Uyar Y. [Frontal sinus obliteration with pericranial-subgaleal flap]. Kulak Burun Bogaz Ihtis Derg. 2010;20:13-7 pubmed
    ..We evaluated the results of patients who underwent frontal sinus obliteration with vascularized pericranial-subgaleal flap...
  42. Prulière Escabasse V, Coste A. Image-guided sinus surgery. Eur Ann Otorhinolaryngol Head Neck Dis. 2010;127:33-9 pubmed publisher
  43. Seker A, Inoue K, Osawa S, Akakin A, Kilic T, Rhoton A. Comparison of endoscopic transnasal and transoral approaches to the craniovertebral junction. World Neurosurg. 2010;74:583-602 pubmed publisher
    ..The study compared the endoscopic anatomy of the transnasal and transoral approaches to the craniovertebral junction (CVJ)...
  44. Elstner K, Clarke F, Turner S. Case report: management of persistent dural anastomotic dehiscence in a patient treated with bevacizumab. Ann Plast Surg. 2013;71:652-3 pubmed publisher
    ..Twenty such cases were found cited in the literature; however, only one study was found which specifically considered angiogenesis inhibitors within the context of central nervous system malignancies...
  45. Beleña J, Nunez M, Yuste J, Plaza Nieto J, Jiménez Jiménez F, Serrano S. Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch. Acta Anaesthesiol Scand. 2012;56:1332-5 pubmed publisher
    ..We consider that simultaneous use of two EBP could be useful as a novel treatment in those cases of SIH without demonstration of CSF leakage...
  46. YANG A, Wickremesekera A, Parker A, Davis C. Surgical management of craniofacial and skull base rhabdomyosarcomas. J Craniofac Surg. 2009;20:1388-93 pubmed publisher
    ..These tumors are highly heterogeneous, and the initial presentation may be insidious. We wished to determine how diagnostic difficulties could be overcome and how management outcomes could be optimized...
  47. Hou W, Wen Y, Wang Z, Zhu X, Wen W. Clinical analysis of the cranial complications of endoscopic sinus surgery. Acta Otolaryngol. 2013;133:739-43 pubmed publisher
    ..Being aware of cranial complications in time and provision of appropriate treatment may minimize the serious consequences...
  48. Hashizume K, Watanabe K, Kawaguchi M, Fujiwara A, Furuya H. Evaluation on a clinical course of subdural hematoma in patients undergoing epidural blood patch for spontaneous cerebrospinal fluid leak. Clin Neurol Neurosurg. 2013;115:1403-6 pubmed publisher
    ..However, a clinical course of SDH in SIH patients has not been sufficiently evaluated. We retrospectively evaluated the temporal relationships between EBP and SDH in the patients with SIH...
  49. Forer B, Sethi D. Endoscopic repair of cerebrospinal fluid leaks in the lateral sphenoid sinus recess. J Neurosurg. 2010;112:444-8 pubmed publisher
    ..The authors present their experience with repairs of 10 CSF leaks that were confined to the lateral sphenoid recess and were treated at the Singapore General Hospital...
  50. Habu M, Niiro M, Toyoshima M, Kawano Y, Matsune S, Arita K. Transethmoidal meningoencephalocele involving the olfactory bulb with enlarged foramina of the lamina cribrosa--case report. Neurol Med Chir (Tokyo). 2009;49:269-72 pubmed
    ..Basal cephalocele should be considered in a patient with recurrent rhinorrhea and intracranial infections, even in the absence of any apparent anomaly...
  51. Fan J, Peng Y, Qi S, Zhang X, Qiu B, Pan J. Individualized surgical strategies for Rathke cleft cyst based on cyst location. J Neurosurg. 2013;119:1437-46 pubmed publisher
    ..The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs...
  52. Zappella N, Barrelet A, Pangon B, Laurent V, Bruneel F. [Group A streptococcal meningitis: Streptococcus pneumoniae is not the only one to seep into the CSF fluid leak!]. Ann Fr Anesth Reanim. 2013;32:811-3 pubmed publisher
  53. Shinonaga M. [The present state and view of the cerebrospinal fluid hypovolemia research]. Nihon Rinsho. 2013;71:1871-8 pubmed
    ..Neither the mechanism of the cerebrospinal fluid leak nor the mechanism of symptoms are understood well. The pathophysiology of cerebrospinal fluid hypovolemia is expected by researching the cerebrospinal fluid circulation...