CSF rhinorrhea
Updates to Article Attributes
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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 4
- congenital
- meningocele
- encephalocele / nasal encephaloceles
- persistent craniopharyngeal canal
- acquired
- traumatic: closed head trauma with an anterior base of skull fracture is the most common cause of CSF rhinorrhoea 2; natural barriers between the anterior cranial fossa and paranasal sinuses can be disrupted, leading to rhinorrhoea, depending on the severity of trauma
- iatrogenic
- multiple neurosurgical procedures involving the skull base, e.g. transsphenoidal pituitary surgeries
- complex operations at the skull base
- otolaryngology procedures such as septoplasty and endoscopic surgery
- non-traumatic
- spontaneous: chronic elevated intracranial pressure (pseudotumour cerebri) with medial sphenoid meningocele formation
- tumours: malignant nasopharyngeal and skull base tumours invading or involving the skull base can cause CSF rhinorrhoea
Anatomical locations 4
- cribriform plate: it is the most common site for spontaneous CSF rhinorrhea
- sphenoid: occur at the perisellar region and the lateral recess of the sphenoid sinus
- temporal bone and middle ear: common sites are the tegmen tympani and tegmen mastoideum
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 dependent on patient 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
Nuclear medicine
- 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>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 href="/articles/anterior-cranial-fossa">anterior cranial fossa</a> and <a href="/articles/paranasal-sinuses">paranasal sinuses</a> can be disrupted, leading to rhinorrhoea, depending on the severity of trauma</li>- +<li>traumatic: closed head trauma with an anterior <a href="/articles/basilar-fractures-of-the-skull">base of skull fracture</a> is the most common cause of CSF rhinorrhoea <sup>2</sup>; natural barriers between the <a href="/articles/anterior-cranial-fossa">anterior cranial fossa</a> and <a href="/articles/paranasal-sinuses">paranasal sinuses</a> can be disrupted, leading to rhinorrhoea, depending on the severity of trauma</li>
-<a title="Cribriform plate" href="/articles/cribriform-plate">cribriform plate</a>: it is the most common site for spontaneous CSF rhinorrhea</li>- +<a href="/articles/cribriform-plate">cribriform plate</a>: it is the most common site for spontaneous CSF rhinorrhea</li>
References changed:
- 5. La Fata V, McLean N, Wise S, DelGaudio J, Hudgins P. CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings. AJNR Am J Neuroradiol. 2008;29(3):536-41. <a href="https://doi.org/10.3174/ajnr.A0885">doi:10.3174/ajnr.A0885</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18079188">Pubmed</a>
- 6. Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H. Endoscopic management of cerebrospinal fluid rhinorrhea. (2016) Asian journal of neurosurgery. 11 (3): 183-93. <a href="https://doi.org/10.4103/1793-5482.145101">doi:10.4103/1793-5482.145101</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27366243">Pubmed</a> <span class="ref_v4"></span>
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