Spontaneous CSF rhinorrhea : management protocol according to clinical presentation

Abstract EN

Objective: The aim of this study is to share our protocol and experience in the management of cases of Spontaneous CSF Rhinorrhea cases.

Methods: This is a retrospective study of 50 consecutive patients (21 male: 29 female) who presented with spontaneous CSF leak from March 2003 to March 2013 and were managed in the neurosurgical department in King Hussein Medical Center (KHMC).The investigations, site of leakage, line of management taken, mortality and morbidity were reviewed and studied.

Results: All our patients presented with spontaneous rhinorrhea, 6 female patients were diagnosed to have Idiopathic Intracranial Hypertension (IIH) and one male had obstructive hydrocephalus and all were treated by CSF diversion.

Forty-three patients had CT or MR cisternography: in 16 patients the site of the leak was apparent and were subjected to direct surgical repair, 27 patients whose cisternography was negative were managed in a stepwise protocol: the first step was medical treatment to decrease CSF production and restricted activities for 10 days, the second step is external lumbar drainage (ELD) insertion for the non-responders by the 3rd day and was used in seven patients, and the third step is permanent CSF diversion and was used in two patients where the leak recurred after the discontinuation of the drain.

No treatment-related mortality or morbidity.

No late recurrences.

Conclusion: Good results can be achieved in managing cases of spontaneous CSF leak, this can be done by categorizing the patients who have increased intracranial pressure or not.

Leaks secondary to high intracranial pressure are managed by diversion procedures, while detectable defects are best managed by direct repair and in other cases a stepwise management is appropriate