Cerebrospinal fluid rhinorrhea

Abstract

Cerebrospinal fluid rhinorrhea poses a problem both as to diagnosis and treatment. It is rarely difficult to establish the fact of leakage, but the exact localization is at times difficult, even with the aid of tomography, air or positive contrast encephalography, the use of radioisotopes and other methods. The fistulous tract, in some cases, is identified only at exploration. A group of 40 patients with CSF rhinorrhea is presented. In 26 the etiological factor was trauma and in 10 rhinorrhea followed an operation. The cause of the rhinorrhea was unknown in 4 patients. There were 22 episodes of meningitis in this group, of which 15 occurred in 1 patient. The rate of meningitis in the entire group was 20%. Since rhinorrhea carries such a high risk of infection, treatment is necessary. Conservative treatment consisting of prolonged continuous (lumbar) CSF drainage and later acetazolamide was tried in each case. This regimen proved successful in 27 out of the 40 patients. The other 13 patients underwent 30 surgical procedures, of which 12 were attempts at closure in a single patient until finally the fistulous tracts were sealed. There were 2 deaths, both of infection. In cases without preceding trauma, the underlying basic lesion should be sought and treated. The failure of surgical closure of the leak may indicate cerebrospinal fluid malabsorption.