J Rhinol.  2017 May;24(1):37-41. 10.18787/jr.2017.24.1.37.

Endoscopic Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea with a Nasoseptal Flap

• Lee SK
• Jung JH
• Lee SJ
• Lee JY

• KMID: 2379788
• DOI: http://doi.org/10.18787/jr.2017.24.1.37

Abstract

Cerebrospinal fluid (CSF) rhinorrhea is classified into traumatic and non-traumatic types. Traumatic CSF rhinorrhea comprises the majority of cases, and major causes include head trauma, rhinologic procedures, and neurosurgery. Non-traumatic (spontaneous) CSF rhinorrhea with normal cerebrospinal pressure is a rare condition, occurring in only 4% of cases. We recently experienced a case of spontaneous CSF rhinorrhea complicated with bacterial meningitis. The defect site was identified in the left sphenoid sinus and was successfully repaired with a nasoseptal flap under an endoscopic approach. We present the etiology, classification, and treatment of this rare disease entity with a review of the literature.

Keyword

Cerebrospinal fluid; Rhinorrhea; Spontaneous; Septal; Flap

MeSH Terms

Cerebrospinal Fluid
Cerebrospinal Fluid Rhinorrhea*
Classification
Craniocerebral Trauma
Meningitis, Bacterial
Neurosurgery
Rare Diseases
Sphenoid Sinus

Figure

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  Fig. 1. Axial ( A) and coronal ( B) sections of preoperative computed tomography and magnetic resonance imaging ( C). The arrows indicate fluid collection in the left sphenoid sinus.

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  Fig. 2. Findings of metrizamide computed tomography cister-nography. Arrow indicates bony defect of posterolateral wall of the left sphenoid sinus.

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  Fig. 3. Endoscopic findings and schematic illustration of pedicled nasoseptal flap. Cerebrospinal fluid leakage was identified at the posterolateral wall of the left sphenoid sinus ( arrow) ( A). Harvest of the nasoseptal flap ( B). Cerebrospinal fluid leakage site was cov-ered with nasoseptal flap ( C).

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  Fig. 4. Foley catheter was inserted and inflated in the left sphenoid sinus for compression of the flap to the defect site.

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  Fig. 5. Postoperative endoscopic finding of the left sphenoid sinus. Completely healed nasoseptal flap is observed 4 months postoperatively.

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