CSF rhinorrhea

CSF rhinorrhea refers to a symptom of cerebrospinal fluid (CSF) leakage extracranially into the paranasal sinuses, thence into the nasal cavity, and exiting via the anterior nares. It can occur whenever there is an osseous or dural defect of the skull base (cf. CSF otorrhea).

  • acquired
    • chronic elevated intracranial pressure (pseudotumor cerebri) with medial sphenoid meningocele formation
    • traumatic: closed head trauma with an anterior base of skull fracture is the most common cause of CSF rhinorrhea 2; natural barriers between the anterior cranial fossa and paranasal sinuses can be disrupted, leading to rhinorrhea, depending on the severity of trauma
    • iatrogenic
      • multiple neurosurgical procedures involving the skull base, e.g. transsphenoidal pituitary surgeries, can result in CSF leak
      • complex operations at the skull base are more likely to result in CSF leaks
      • otolaryngology procedures such as septoplasty and endoscopic surgery can also result in CSF leaks
    • tumors: malignant nasopharyngeal and skull base tumors invading or involving the skull base can cause CSF rhinorrhea
  • congenital
  • large osseous defects can be visualized on plain CT
  • CT cisternography is the diagnostic modality for diagnosing an occult site of CSF leak. It is performed after injecting contrast into the theca; however, this procedure is highly dependent on patient positioning and timing
  • 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
  • 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.

Article information

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

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Cases and figures

  • Case 1: CT cisternography
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  • Case 2
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  • Case 3
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  • Case 4: sphenoid encephalocele
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  • Case 5
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