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J Neurol Surg B Skull Base 2018; 79(02): 193-199
DOI: 10.1055/s-0037-1606306
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Surgical Outcomes and Postoperative Management in Spontaneous Cerebrospinal Fluid Rhinorrhea

Authors

  • Zi Yang Jiang

    1   Department of Otolaryngology – Head and Neck Surgery, University of Texas Health Science Center in Houston, Houston, Texas, United States

  • Caitlin McLean

    2   Department of Otolaryngology – Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, United States

  • Carlos Perez

    3   Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States

  • Samuel Barnett

    4   Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States

  • Deborah Friedman

    5   Departments of Neurology & Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center Dallas, Texas, United States

  • Bobby A. Tajudeen

    6   Department of Otorhinolaryngology – Head and Neck Surgery and Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, United States

  • Pete S. Batra

    6   Department of Otorhinolaryngology – Head and Neck Surgery and Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, United States

Funding Source None.
Further Information

Publication History

10 April 2017

26 July 2017

Publication Date:
04 September 2017 (online)

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Abstract

Background The etiology of spontaneous cerebrospinal fluid (CSF) rhinorrhea remains unknown, though emerging evidence suggests that this likely represents a variant of idiopathic intracranial hypertension. Long-term success rates for repair and postoperative management strategies remain variable.

Methods Retrospective review of patients undergoing surgical management of spontaneous CSF rhinorrhea was conducted over a 5-year period. Analysis was performed to correlate recurrence with demographics and perioperative variables. Lumbar puncture usage and neuro-ophthalmological examinations in clinical management were also assessed.

Results Forty-eight patients were included in the study. The mean age was 51.4 years with 94% females. Leaks were most commonly located in the sphenoid (43.8%) and cribriform region (33.3%). The most common findings on magnetic resonance imaging were empty sella (48%) and Meckel's cave diverticula (24%). Nine patients (18.8%) had recurrent CSF leaks. Six occurred >1 month postoperatively. Three had repeat endoscopic repairs, two received ventriculoperitoneal shunts, and one was managed with a lumbar drain, with overall success rate of 93.8%. Acetazolamide was utilized in 19 cases (39.6%) postoperatively. Overall, 59% of patients had elevated opening pressures on postoperative lumbar puncture (n = 32). Neuro-ophthalmology evaluated 28 patients; 25% had visual field deficits, and 7.1% had papilledema.

Conclusions Management of spontaneous CSF leaks remains a significant challenge. Endoscopic repair is successful in most patients with little morbidity; however, postoperative management remains inconsistent, and further studies are warranted to establish consensus on post-surgical care. The association with elevated intracranial pressure and visual field deficits/papilledema suggests opening pressures, and neuro-ophthalmologic evaluation should be considered in the treatment algorithm.

Keywords

endoscopy - cerebrospinal fluid - leak - rhinorrhea - spontaneous - skull base - intracranial hypertension

Financial Disclosures

Pete S. Batra received research grant from Medtronic, is a consultant at Acclarent, and accepted royalties From Springer. The remaining authors have nothing to disclose.