CSF rhinorrhoea

CSF rhinorrhoea refers to a symptom of CSF leakage extracranially into paranasal sinuses. It can occur whenever there is osseous or dural defect of the skull base.

Aetiology
  • acquired
    • chronic elevated ICP (pseudotumour cerebri) with medial sphenoid meningocoele formation
    • traumatic: closed head trauma is most common cause for CSF rhinorrhoea 2, natural barriers between anterior cranial fossa and paranasal sinuses can be disrupted leading to rhinorrhoea based on severity of trauma
    • iatrogenic
      • multiple neurosurgical procedures involving skull base like trans-sphenoidal pituitary surgeries can result CSF leak
      • complicated surgeries at the skull base are more likely result in CSF leaks
      • otolaryngology procedures like septoplasty and endoscopic surgery can also result in CSF leaks
    • tumours: malignant nasopharyngeal and skull base tumors like invading or involving skull base can cause CSF rhinorrhoea
  • congenital
CT
  • large osseous defects can be visualised on plain CT
  • CT cisternography is the diagnostic modality for diagnosing an occult site of CSF leak. It is performed after injecting contrast into thecal sac; however, this procedure highly depends on the patient's position and timing
MRI
  • 3D high resolution T2W and T1W sequences are useful in diagnosing this condition
  • coronal reformations can depict the osseous defects with a greater degree of accuracy
Radionuclide studies
  • have higher sensitivity in diagnosing leaks but have poor anatomic resolution

Leakage of spinal fluid into either the nose or the ear was first described as a pathologic entity in 1899 by Sir St Clair Thomson 3.

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Article Information

rID: 25471
Section: Pathology
Tags: cases, refs
Synonyms or Alternate Spellings:
  • Cerebrospinal fluid rhinorrhea
  • CSF rhinorrhea
  • Cerebrospinal fluid rhinorrhoea

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Cases and Figures

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    Case 1: CT cisternography
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    Case 2
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    Case 3
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    Case 4: sphenoid encephalocoele
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    Case 5
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