J Neurol Surg B Skull Base 2014; 75 - a091
DOI: 10.1055/s-0034-1383995

Long-Term Surgical Outcomes of Spontaneous CSF Rhinorrhea

Z. I. Yang Jiang 1, C. Mclean 1, C. Perez 1, S. Barnett 1, D. Friedman 1, P. Batra 1
  • 1University of Texas Southwestern, United States

Background: The etiology of spontaneous cerebrospinal fluid (CSF) rhinorrhea is uncertain but some patients with CSF leaks suffer from idiopathic intracranial hypertension (IIH). Objectives: (1) To determine the rate of recurrent CSF leaks after initial repair and correlate with patient demographics, operative, and postoperative care variables.(2) To determine the prevalence of IIH in these patients.(3) To evaluate the role of lumbar puncture (LP) and neuroophthalmological examinations in demonstrating abnormal findings or change in clinical management. Methods: Retrospective review of patients undergoing operative repair of spontaneous CSF rhinorrhea between January, 2008 and December, 2013. Results: A total of 48 patients were included in the study (94% women). The location of the leaks was most commonly in the ethmoid roof (48%) and sphenoid (42%). The most common finding on MRI (n = 24) was an empty sella (46%). Nine patients (18.8%) had recurrent CSF leaks: 6 occurred >1 month postoperatively. Three had repeat transnasal endoscopic repairs, two received ventriculoperitoneal shunts, one was managed with a lumbar drain, and three were lost to follow-up. Acetazolamide use was inconsistent (n = 18). On postoperative LP (n = 32), 59% of patients had elevated opening pressures (>20 cm H2O). Neuroophthalmology evaluated 28 of the patients: 7 (25%) patients had visual field deficits and 2 (7%) had papilledema. Conclusions: IIH represents a subset of patients with spontaneous CSF leaks. The finding of papilledema was associated with elevated CSF pressures. Care remains inconsistent and further studies are warranted to establish consensus on operative and postoperative management of patients with spontaneous CSF rhinorrhea.