CSF rhinorrhoea: Treatment, symptoms, advice and help

Definition

This condition is characterised by the flow of cerebro-spinal fluid from the nose or clearing backwards from the nose into the throat.

Incidence/Age

This is a very rare condition when spontaneous, however it can be seen in the presence of trauma to the skull or following skull base surgery.

Causes

1. Traumatic: from fractures to the skull base including the area adjacent to the nasal cavity, whereby tearing of the linings of the brain allow cerebro-spinal fluid to leak into the nose.
2. Spontaneous: arising from a congenital defect within the area adjacent to the nose and brain, allowing leakage of the CSF into the nose, or due to destructive lesions and tumours in this area eroding into the bony partition in between the nose and brain.

Symptoms/Signs

Watery fluid arising from the right or left side of the nose, frequently noted when bending forwards.

Complications of the Disorder

Meningitis. Indeed this condition may be the presenting symptom for CSF rhinorrhoea.

Tests

The fluid arising from the nose can be tested for a particular protein, thus proving the origin for the fluid to be from the cerebro-spinal fluid. Scans including MRI scanning and CT scanning may be required to identify the precise area of leakage for the CSF. This may also involve inserting fluorescein or a similar dye to the CSF space using a lumbar puncture then observing the leakage within the nose.

Treatment

Depending upon the site of origin of the leak and the possible access to the area, the repair may involve an endoscopic approach through the nose and sinuses or a formal craniotomy to open the skull to retract the brain and apply the graft material to the leaking site.

Outcome/Prognosis

If treated successfully, then the leak will stop. However, this can occasionally be difficult and the leak could persist and require further repair. If un-repaired, the prospect for meningitis occurring remains a significant possibility.

Mr D Skinner FRCS