Spontaneous Cerebrospinal Fluid Rhinorrhea, is a Lumbar Drain Indicated?

Introduction: Cerebrospinal fluid (CSF) rhinorrhea occurs due to direct connection between the subarachnoid space and nasal and paranasal sinus mucosa . This connection could be a congenital skull base defect or an acquired defect due to trauma, neoplasms or benign intracranial hypertension (BIH). In today’s practice, endoscopic repair is considered the gold standard treatment in spontaneous CSF leak repair. In this study we aim to evaluate the treatment outcome of spontaneous CSF leak cases at our institution.

Materials and Methods: Retrospective chart review of all patients who had spontaneous CSF rhinorrhea and underwent endoscopic repair between December 2011 and August 2016. Data collected included: patient demographics, etiology, location of skull base defect, surgical technique, recurrence, use of lumbar drains, follow up duration and the presence of meningoceles.

Results: Thirty-five patients met our inclusion criteria, 76% of which were females. Mean values for age and BMI were 50 years and 36.9 respectively. 20 patients had defects in the ethmoidal region including a case with bilateral ethmoidal defects and 15 with sphenoidal defects. 32 defects were reconstructed exclusively using allogenic grafts. None of the subjects required a lumbar drain with the exception of 1 patient who had a lumboperitoneal shunt remotely prior to surgery. Reconstruction was successful in our series without reported recurrence.

Conclusion: Endoscopic repair of spontaneous CSF leak can be achieved successfully with allogenic grafts, while free mucosal grafts may be utilized to enhance mucosalization. In our experience, measures to decrease intracranial pressure were not required for postoperative success.