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CSF Rhinorrhea - Cerebrospinal Fluid Rhinorrhea

CSF Rhinorrhea - Cerebrospinal Fluid Rhinorrhea
10 Jul, 2017

CSF rhinorrhea is condition in which there is an abnormal communication between the brain and the nose or the paranasal sinuses. The fluid that normally bathes the human brain is encapsulated by layers and any abnormal communication can lead to the condition which is known as CSF rhinorrhoea. This can lead to meningitis and intracranial infections and can also result in development of pneumocephalus and secondary brain compression.

Causes Of CSF Rhinorrhea

Most of the cases of CSF rhinorrhea are due to trauma but it is also in spontaneously and in non-traumatic cases.

Traumatic cases of CSF rhinorrhea have a propensity to spontaneously resolve with conservative management, although larger defects created may to be managed surgically. However, in cases of spontaneous CSF leaks there is a need to identify the leak accurately and then manage the leak depending on the cause which could be either associated with abnormal CSF pressures or normal pressures.

Diagnosis

It is important to accurately identify a CSF leak as it has important clinical implications. It is prudent to differentiate the condition from other rhinopathies such as seasonal allergic rhinitis, perennial non allergic rhinitis and vasomotor rhinitis which are relatively common. A patient’s clinical history provides important clues to the diagnosis of the condition. There is typically a history of clear watery discharge from the nose aggravated on bending down, which cannot be sniffed back into the nose, occasionally associated with salty taste.

A history of trauma, surgery for the nose or sinuses or skull base procedures could provide vital clues about the etiology.

CSF rhinorrhea can be detected with the help of some tests on the fluid collected from the nose. These tests include determination of glucose levels and some specific tests are also available.

However it is important to identify the site of the leak which can be determined with the help of radiological investigations which also help to confirm the leak. These tests include CT cisternography and MR cisternography. The probability of detecting CSF leak with CT cisternography is about 80% and with MR cisternography is about 78%, the advantage of MR cisternography it being a non-invasive procedure.

Management

Most of the traumatic leaks can be managed conservatively; however the spontaneous, idiopathic leaks need to be addressed surgically.

Most of the leaks in the nose and paranasal region can be addressed by endoscopic endonasal approach using allografts, free mucosal flaps, xenografts for the repair of the leaks. Though there is a need for coordination with the neurosurgeon and the infection control specialist, the condition can be effectively addressed by a trained otolaryngologist, thereby significantly reducing the morbidity and the hospital days.

Categories: Nose and Sinus

Tags: Nose and Sinus