Spontaneous CSF Rhinorrhea: Prevalence of Multiple Simultaneous CSF Leaks and Skull Base Defects

Objective: To report the University of Miami experience treating patients with spontaneous CSF rhinorrhea and to determine the prevalence of having multiple concurrent sites of leak and/or skull base defects at the time of surgery.

Design: Retrospective study.

Setting: Academic hospital.

Patients: Consecutive patients who presented to the senior author with a spontaneous CSF rhinorrhea and underwent endonasal endoscopic surgery from January 2004 to July 2012.

Methods: Clinical charts of patients with CSF rhinorrhea were retrospectively reviewed. All of these patients were managed with an endonasal endoscopic procedure.

Results: Thirty consecutive patients underwent 31 procedures. At the time of surgery, a single CSF fistula was found in the cribriform plate in 10 patients and within the sphenoid sinus in 15 patients; multiple sites with a skull base defect were concurrently found in 5 patients (17%). In two of these patients, there were multiples defects within the cribriform plate. In two patients, concurrent leaks were found from the sphenoid and frontal sinuses. One of the latter patients developed an additional leak from the fovea ethmoidalis over a year after the initial repair. One patient had a concurrent leak from the cribriform plate and tegmen tympani. Alloderm was used for repair in all but one case. The male-to-female ratio was 6:24. The average BMI was 35.2. A lumbar drain was used in only one patient. Intrathecal fluorescein was used in all cases and was especially helpful in cases with multiple defects. Follow-up ranged from 1 week to 5 years (average, 8.4 months). There were no recurrent leaks and an overall success rate of 100%. Complications included V2 parasthesia (2), anosmia (1), and frontal lobe abscess (1).

Conclusions: The endoscopic endonasal approach for the treatment of CSF leaks of the anterior skull base is the preferred method of repair in the vast majority of cases. In this patient population, a significant percentage of patients may have multiple sites of CSF leak. In such cases, preoperative intrathecal fluorescein is especially helpful in identifying all skull base defects.