Clinical case of multiple minor defect on anterior skull base and role of usage the fluorescein intrathecal in detection of cerebrospinal fluid rhinorrhea

Introduction:

Cerebrospinal fluid (CSF) rhinorrhea is the result of pathologic communication between the intracranial subarachnoid space and the sinonasal cavities. It could be due to trauma, raised intracranial pressure (ICP), tumors, and congenital skull base defects. The imaging methods – CT scan and MRI are very informative but in some cases insufficient for identify the minor defects. Severe and life-threatening intracranial complications are possible like pneumocephalus, ascending bacterial meningitis, brain abscess, mucocele formations but on-time diagnosis prevents them.

Methods:

In our reported case, the female patient I. P., 58 years old, presented with spontaneous cerebrospinal fluid leak rhinorrhea. She was treated for allergic rhinitis. In the last 10 years she had meningitis three times and all imaging results showed sphenoid sinusitis. She had positive nasal secretion for b 2 transferrin.

Results:

We used endoscopic endonasal approach for repair the suspected area, but the CT results wasn't sufficient for the identification of the defect. We performed repair, but in the postoperative period the CSF leak persisted. We applied fluorescein intrathecal and detected multiple minor defects. We didn't register any operative and postoperative complications with successful repair by using on lay techniques. One year later, there isn't any evidence of CSF leak rhinorrhea.

Conclusion:

In some of the cases the usage of fluorescein has to be restricted and applied in indicated cases. Even with minor experience, we saw the positive side and potential of this method.

Publication History

Publication Date:
23 April 2019 (online)