CSF rhinorrhoea refers to the drainage of cerebrospinal fluid through the nose.
Endoscopic management is the most useful approach for most of the cases. /viewarticle/936392 Hence, the surgical team should be prepared to repair the resulting CSF leak at the time of the resection, either transcranially or endoscopically.Defects in the closure of the anterior neuropore can result in the herniation of central nervous tissue through anterior cranial fossa. The leak almost never recurs. Measures of CSF components such as glucose have been used in the past, but are neither sensitive nor specific; beta-2 transferrin, however, has been shown to have a high positive predictive value. However, the presence of a ring sign is not exclusive to CSF and can lead to false-positive results.Unless medical or surgical contraindications exist, surgical repair is recommended in all patients with spontaneous or iatrogenic cerebropsinal fluid (CSF) rhinorrhea in order to prevent ascending meningitis.In patients with nonsurgical trauma, waiting a period of 5-7 days to allow conservative measures (bed rest, stool softeners, and lumbar drainage) to assist with secondary closure of the traumatic defect is reasonable. Makary CA, Zalzal HG, Ramadan J, Ramadan HH. Conservative [80-82] measures are advised to be utilized postoperatively for most of the cases to avoid failure, which is commonly attributed to inadequate exposure intraoperatively and non appropriate care postoperatively.©2017 Sumaily.
Other common locations include the posterior fovea ethmoidalis and the posterior aspect of the frontal recess.The growth of benign tumors does not commonly result in CSF rhinorrhea.
Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Spontaneous CSF rhinorrhea: prevalence of multiple simultaneous skull base defects. The resulting communication with the central nervous system (CNS) can result in a multitude of infectious complicati… Please refer to Etiology for further details.Cerebrospinal fluid (CSF) leaks are generally classified as traumatic, iatrogenic, and spontaneous/idiopathic. Ray BS, Bergland RM. In cases of iatrogenic and spontaneous leaks, it is less likely to heal with conservative measures. A biopsy should never be obtained unless a complete imaging workup has been conducted.Spontaneous CSF rhinorrhea occurs in patients without antecedent causes. Lemonnier LA, Tessema B, Kuperan AB, et al. A defect in the skull base is measured with a sterile ruler. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Gosal JS, Gurmey T, Kursa GK, Salunke P, Gupta SK. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.Goldenberg D, Goldstein BJ. The sella turcica and sphenoid sinus are involved in 15% of the cases as well.Common sites of injury secondary to endoscopic sinus surgery include the lateral lamella of the cribriform plate and the posterior ethmoid roof near the anterior and medial sphenoid wall. MRI with FLAIR sequence is very useful and specific diagnostic and localizing technique without risk of contrast or radiation exposure, and therefore can be the first single diagnostic [79] modality. In cases of iatrogenic and spontaneous leaks, it is less likely to heal with conservative measures. Non-traumatic CSF rhinorrhea is a relatively rare condition and occurs secondary to different etiologies. If you have cerebrospinal fluid rhinorrhea, it is important for you to receive appropriate treatment to prevent meningitisVery small leaks may only require bed rest and medication to resolve. In most cases of iatrogenic injury presenting in a delayed fashion, surgical repair is necessary. The exact incidence of CSF rhinorrhea is unknown but some studies have suggested that the rate of CSF rhinorrhea When trauma is the cause, the interval between trauma and the onset of the leak is important. Iatrogenic causes include neurosurgical and otolaryngologic approaches to neoplastic disease, as well as functional endoscopic sinus surgery (FESS).
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