Download PDF
CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0045-1806926
Case Report

Endoscopic-Assisted Fluorescein-Guided Repair of CSF Rhinorrhea in a Case of Spontaneous CSF Leak

Abhijit Acharya 
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
Souvagya Panigrahi
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
A.K. Mahapatra
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
Rama Chandra Deo 
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background

Cerebrospinal fluid (CSF) leaks in the form of rhinorrheas and otorrheas are known entities in case of traumatic brain injuries. However, spontaneous CSF leaks are rare in incidence. It happens due to a bony defect at the skull base with an associated breach in the dura and arachnoid layer along with a sinonasal disruption.

Material and Methods

We, at this moment, present the case of a 44-year-old woman with a spontaneous onset CSF rhinorrhea for 1 month.

Observation

She was evaluated with imaging CT cisternography. However, as the defect was small, it was difficult to identify the site of CSF rhinorrhea. Therefore, intrathecal fluorescein dye was administered, and the dye could be visualized with the naked eye under endoscopic white light as a green color after 20 to 30 minutes. The location was identified and was plugged with a Hadad flap and fat plug.

Conclusion

The location of the CSF leak needs to be identified with modalities like CT or MR cisternography, but it becomes challenging if the leak site is small. Hence, the use of intraoperative modalities to determine the location of a leak needs to be done meticulously for a successful outcome.

Keywords

CSF rhinorrhea - fluorescein dye - cisternography - intrathecal dye


Publication History

Article published online:
02 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal 2007; 12 (05) E397-E400
    PubMedSearch in Google Scholar
  • 2 Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H. Endoscopic management of cerebrospinal fluid rhinorrhea. Asian J Neurosurg 2016; 11 (03) 183-193
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Yadav YR, Yadav S, Sherekar S, Parihar V. A new minimally invasive tubular brain retractor system for surgery of deep intracerebral hematoma. Neurol India 2011; 59 (01) 74-77
    CrossrefPubMedSearch in Google Scholar
  • 4 Sanderson JD, Kountakis SE, McMains KC. Endoscopic management of cerebrospinal fluid leaks. Facial Plast Surg 2009; 25 (01) 29-37
    PubMedSearch in Google Scholar
  • 5 Golusinski W, Waśniewska E, Kulczyński B. Endoscopic reconstruction of the anterior skull base in cerebrospinal rhinorrhea. Otolaryngol Pol 2003; 57 (01) 75-79
    PubMedSearch in Google Scholar
  • 6 Kirtane MV, Gautham K, Upadhyaya SR. Endoscopic CSF rhinorrhea closure: our experience in 267 cases. Otolaryngol Head Neck Surg 2005; 132 (02) 208-212
    PubMedSearch in Google Scholar
  • 7 Jones MR, Shlobin NA, Dahdaleh NS. Spontaneous spinal cerebrospinal fluid leak: review and management algorithm. World Neurosurg 2021; 150: 133-139
    PubMedSearch in Google Scholar
  • 8 El-Banhawy OA, Halaka AN, El-Hafiz Shehab El-Dien A, Ayad H. Subcranial transnasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the combined overlay and underlay techniques. Minim Invasive Neurosurg 2004; 47 (04) 197-202
    PubMedSearch in Google Scholar
  • 9 Schick B, Ibing R, Brors D, Draf W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001; 110 (02) 142-147
    CrossrefPubMedSearch in Google Scholar
  • 10 Pérez MA, Bialer OY, Bruce BB, Newman NJ, Biousse V. Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension. J Neuroophthalmol 2013; 33 (04) 330-337
    CrossrefPubMedSearch in Google Scholar
  • 11 Vemuri NV, Karanam LSP, Manchikanti V, Dandamudi S, Puvvada SK, Vemuri VK. Imaging review of cerebrospinal fluid leaks. Indian J Radiol Imaging 2017; 27 (04) 441-446
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Bachert C, Verhaeghe B, van Cauwenberge P, Daele J. Endoscopic endonasal surgery (EES) in skull base repairs and CSF leakage. Acta Otorhinolaryngol Belg 2000; 54 (02) 179-189
    PubMedSearch in Google Scholar
  • 13 Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope 2000; 110 (07) 1166-1172
    CrossrefPubMedSearch in Google Scholar
  • 14 Benedict PA, Connors JR, Timen MR. et al. Detection of cerebrospinal fluid leaks using the endoscopic fluorescein test in the postoperative period following pituitary and ventral skull base surgery. J Neurol Surg B Skull Base 2022; 84 (01) 17-23
    PubMedSearch in Google Scholar
  • 15 Martín-Martín C, Martínez-Capoccioni G, Serramito-García R, Espinosa-Restrepo F. Surgical challenge: endoscopic repair of cerebrospinal fluid leak. BMC Res Notes 2012; 5: 459
    CrossrefPubMedSearch in Google Scholar
  • 16 Kansu L, Akkuzu B, Avci S. Endoscopic treatment of idiopathic spontaneous although cerebrospinal fluid rhinorrhea: a case report. Kulak Burun Bogaz Ihtis Derg 2009; 19 (01) 36-40
    PubMedSearch in Google Scholar
  • 17 Sughrue ME, Aghi MK. Reconstruction of dural defects of the endonasal skull base. Neurosurg Clin N Am 2010; 21 (04) 637-641 , vi
    PubMedSearch in Google Scholar
  • 18 Landeiro JA, Lázaro B, Melo MH. Endonasal endoscopic repair of cerebrospinal fluid rhinorrhea. Minim Invasive Neurosurg 2004; 47 (03) 173-177
    PubMedSearch in Google Scholar
  • 19 Galli J, Morelli F, Rigante M, Paludetti G. Management of cerebrospinal fluid leak: the importance of multidisciplinary approach. Acta Otorhinolaryngol Ital 2021; 41 (Suppl. 01) S18-S29
    PubMedSearch in Google Scholar
  • 20 Yadav YR, Parihar V, Agarwal M, Sherekar S, Bhatele P. Endoscopic vascular decompression of the trigeminal nerve. Minim Invasive Neurosurg 2011; 54 (03) 110-114
    PubMedSearch in Google Scholar
  • 21 Platt MP, Parnes SM. Management of unexpected cerebrospinal fluid leak during endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (01) 28-32
    PubMedSearch in Google Scholar
  • 22 Nyquist GG, Anand VK, Mehra S, Kacker A, Schwartz TH. Endoscopic endonasal repair of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles. J Neurosurg 2010; 113 (05) 961-966
    CrossrefPubMedSearch in Google Scholar