Short case series of different causes of a cerebrospinal fluid rhinorrhoea

Purpose/Objectives: 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.
Methods and materials: We present two cases of CSF rhinorrhea caused by
diverse etiology and treated with different surgical approaches.
Result: A 72-year-old woman with a 6-month history of left-sided intermittent
nasal discharge and mild headache. This was identified to be CSF caused
by intrasphenoidal 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. The patient underwent a functional endoscopic sinus surgery – with the resection of meningoencephaloce and closure of the defect with fascia lata lever. There
were no complications related to the surgery and no recurrence of CSF leakagein 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 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, as well as periventricular edema, most likely, 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.
Conclusion: CSF rhinorrhoea is a relatively rare condition occurring secondary to different etiology, however, it can be clinically noticeable or insidious. A comprehensive diagnostic assessment of individuals clinically suspected of having CSF rhinorrhea is critical, along with an understanding of CSF components and imaging abnormalities.