CSF rhinorrhea
Updates to Article Attributes
Body
was changed:
CSF rhinorrhoea refers to a symptom of cerebrospinal fluid (CSF) leakage extracranially into the paranasal sinuses, thence into the nasal cavity, and exiting via the anterior nares. It can occur whenever there is an osseous or dural defect of the skull base (cf. CSF otorrhoea).
Pathology
Aetiology
- acquired
- chronic elevated intracranial pressure (pseudotumour cerebri) with medial sphenoid
meningocoelemeningocele formation - traumatic: closed head trauma with an anterior base of skull fracture is the most common cause
forof CSF rhinorrhoea 2,; natural barriers between the anterior cranial fossa and paranasal sinuses can be disrupted, leading to rhinorrhoeabased, depending on the severity of trauma - iatrogenic
- multiple neurosurgical procedures involving the skull base, e.g. trans-sphenoidal pituitary surgeries, can result in CSF leak
-
complicated surgeriescomplex operations at the skull base are more likely to result in CSF leaks - otolaryngology procedures
likesuch as septoplasty and endoscopic surgery can also result in CSF leaks
- tumours: malignant nasopharyngeal and skull base tumours
likeinvading or involving the skull base can cause CSF rhinorrhoea
- chronic elevated intracranial pressure (pseudotumour cerebri) with medial sphenoid
- congenital
- meningocele
- encephalocele / nasal encephaloceles
- persistent craniopharyngeal canal
Radiographic features
CT
- large osseous defects can be visualised on plain CT
-
CT cisternography is the diagnostic modality for diagnosing an occult site of CSF leak. It is performed after injecting contrast into the theca; however, this procedure is highly
dependsdependent onthe patient's positionpatient positioning and timing
MRI
- 3D high-resolution T2W and T1W sequences are useful in diagnosing this condition
- coronal reformations can depict the osseous defects with a greater degree of accuracy
Radionuclide studies
- have higher sensitivity in diagnosing leaks but have poor anatomic resolution
History and etymology
Leakage of spinal fluid into either the nose or the ear was first described as a pathologic entity in 1899 by Sir St Clair Thomson 3.
-<li>chronic elevated intracranial pressure (<a href="/articles/idiopathic-intracranial-hypertension-1">pseudotumour cerebri</a>) with medial sphenoid meningocoele formation</li>-<li>traumatic: closed head trauma with an anterior <a href="/articles/base-of-skull-fracture">base of skull fracture</a> is most common cause for CSF rhinorrhoea <sup>2</sup>, natural barriers between anterior cranial fossa and paranasal sinuses can be disrupted leading to rhinorrhoea based on the severity of trauma</li>- +<li>chronic elevated intracranial pressure (<a href="/articles/idiopathic-intracranial-hypertension-1">pseudotumour cerebri</a>) with medial sphenoid meningocele formation</li>
- +<li>traumatic: closed head trauma with an anterior <a href="/articles/base-of-skull-fracture">base of skull fracture</a> is the most common cause of CSF rhinorrhoea <sup>2</sup>; natural barriers between the <a title="Anterior cranial fossa" href="/articles/anterior-cranial-fossa">anterior cranial fossa</a> and <a title="Paranasal sinuses" href="/articles/paranasal-sinuses">paranasal sinuses</a> can be disrupted, leading to rhinorrhoea, depending on the severity of trauma</li>
-<li>multiple neurosurgical procedures involving skull base, e.g. trans-sphenoidal pituitary surgeries, can result in CSF leak</li>-<li>complicated surgeries at the skull base are more likely to result in CSF leaks</li>-<li>otolaryngology procedures like septoplasty and <a href="/articles/functional-endoscopic-sinus-surgery-1">endoscopic surgery</a> can also result in CSF leaks</li>- +<li>multiple neurosurgical procedures involving the skull base, e.g. trans-sphenoidal pituitary surgeries, can result in CSF leak</li>
- +<li>complex operations at the skull base are more likely to result in CSF leaks</li>
- +<li>otolaryngology procedures such as septoplasty and <a title="FESS" href="/articles/functional-endoscopic-sinus-surgery-1">endoscopic surgery</a> can also result in CSF leaks</li>
-<li>tumours: malignant nasopharyngeal and skull base tumours like invading or involving skull base can cause CSF rhinorrhoea</li>- +<li>tumours: malignant nasopharyngeal and skull base tumours invading or involving the skull base can cause CSF rhinorrhoea</li>
-<a href="/articles/ct-cisternography-1">CT cisternography</a> is the diagnostic modality for diagnosing an occult site of CSF leak. It is performed after injecting contrast into the theca; however, this procedure highly depends on the patient's position and timing</li>- +<a href="/articles/ct-cisternography-1">CT cisternography</a> is the diagnostic modality for diagnosing an occult site of CSF leak. It is performed after injecting contrast into the theca; however, this procedure is highly dependent on patient positioning and timing</li>
Images Changes:
Image 4 MRI (T2) ( update )
Caption
was changed:
Case 4: sphenoid encephalocoeleencephalocele
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