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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

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
› Author Affiliations
Funding Source None.
Further Information

Publication History

10 April 2017

26 July 2017

Publication Date:
04 September 2017 (online)

Also available atMedOne
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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.