From Leak to Repair: Journey of CSF Rhinorrhea Patients

Abstract

BACKGROUND: Cerebrospinal Fluid (CSF) rhinorrhea is a potentially life threatening condition characterized by the leakage of CSF through the nasal cavity, resulting from a breach in the dural membranes surrounding the brain and a bony defect. These osteodural defects cause a direct communication between the CSF-containing subarachnoid space and the paranasal sinuses. This condition poses significant threat to transmit bacteria intracranially leading to life threatening meningitis or intracranial infections. It as well poses a diagnostic and therapeutic challenge, necessitating prompt recognition and management to prevent devastating complications.

MATERIAL AND METHOD: Our sample size consisted of 50 patients. Our study is a retrospective cohort study which was conducted for a period of 5 years between January 2018 and December 2022. Descriptive statistics were used to summarize patient demographics and clinical characteristics. Chi-squared tests and Fisher's exact tests were used to compare categorical variables. Continuous variables were compared using t-tests or Mann-Whitney U tests.

RESULTS: The mean age was 48.5 years. CSF rhinorrhea was the presenting symptom in all patients. Majority (58%) of cases seen were traumatic with cribriform plate being the most common location (44%). Endoscopic repair was done in 34 patients, open surgery in 10 patients, and 1 patient underwent VP shunt placement. Spontaneous recovery was seen in 6 patients.

CONCLUSION: Our results support individualized treatment approaches, considering spontaneous recovery, endoscopic repair, and open surgery or shunt placement for complex cases. Our study demonstrates high success rates for endoscopic repair of CSF rhinorrhea, with significant factors influencing outcome.