DISTINCT CAUSES OF CEREBROSPINAL FLUID RHINORRHOEA: TWO CASE REPORTS

Background / Objective
Cerebrospinal fluid (CSF) rhinorrhea refers to a CSF leakage extracranially into the paranasal sinuses, then into the nasal
cavity, and exits via the anterior nares.
CSF rhinorrhea is often seen whenever there is an osseous or dural defect of the skull base, mostly caused by head trauma
or a post-operative complication of skull base surgery, or due to congenital defects.
We present two cases of CSF rhinorrhea caused by diverse etiology and treated with different surgical technique.
Methods
A 72-year-old woman with a 6-month history of left-sided intermittent nasal discharge and mild headache. This was
identified as CSF caused by intra-sphenoidal meningoencephalocele due to the persistence of the lateral craniopharyngeal
canal (Stenberg’s canal).The brain MRI identified a herniated temporal lobe through a bony defect that communicates the
middle cranial fossa with the lateral recess of the sphenoidal sinus. Patient underwent a functional endoscopic sinus surgery
– with the resection of meningoencephalocele and closure of the defect with fascia lata lever. There were no complications
related to surgery and no recurrence of CSF leakage in 6 months.
A 41-year-old male with multiple skull and facial fractures (Le Fort III), a traumatic subarachnoid hemorrhage in the left
frontal lobe, and traumatic brain injury resulting from altercations. He was primarily treated with subsequent facial bone
osteosynthesis using mini and microplates. A month after this episode, the patient was re-admitted to another hospital due to
progressive headache, subfebrile temperature, and persistent watery nasal discharge. Brain non-enhanced CT was
repeated demonstrating diffuse pneumocephalus and cerebrospinal fluid circulation abnormalities with signs of
transtentorial herniation and brain edema. Progressive widening of cerebral ventricles was noted, including temporal horns
as well as periventricular edema. Most likely patient presented with acute communicating hydrocephalus due to meningitis.
The patient underwent a right ventriculostomy with an antimicrobial drain, followed by a ventriculoperitoneal shunting
procedure. Shortly after, the CSF rhinorrhea resolved.
Results
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Conclusions
CSF rhinorrhea is relatively rare condition occurring secondary to different etiology, however, diagnosing its possible cause
can be challenging. A comprehensive diagnostic assessment of individuals clinically suspected of having CSF rhinorrhea is
critical, along with an understanding of CSF components and imaging abnormalities