Primary spontaneous cerebrospinal fluid rhinorrhea: a symptom of idiopathic intracranial hypertension?

Clinical article

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Object

The authors aim to identify the characteristics of primary spontaneous CSF rhinorrhea and propose a hypothesis for its pathogenesis.

Methods

Between 2003 and 2009, 21 patients diagnosed with primary spontaneous CSF rhinorrhea underwent surgery in the authors' hospital. The clinical aspects were retrospectively reviewed, and their characteristics were analyzed.

Results

There were 18 women and 3 men, whose ages ranged from 37 to 74 years (mean 53 years). Body mass index (BMI) ranged from 22 to 58.8 kg/m2 (mean 31.2 kg/m2). Eighteen patients (85.7%) were overweight, and 18 (85.7%) suffered from headache or tinnitus before rhinorrhea. Radiological images revealed fully or partially empty sellae in 14 patients (66.7%). The preoperative intracranial pressure (ICP) ranged from 11 to 28 cm H2O (mean 17.6 cm H2O), while the postoperative ICP ranged from 21 to 32 cm H2O (mean 25.5 cm H2O, p < 0.01). An endoscopeassisted transnasal approach was chosen for the repair. Postoperatively, in 95.2% of patients a cure was achieved. Rhinorrhea recurred in only 1 patient, and a leakage from a new defect occurred in another patient 4 years after the operation. Both patients underwent additional surgery, which was successful. The follow-up period varied from 5 to 75 months with a mean of 34 months.

Conclusions

All patients had direct or indirect evidence of elevated ICP, most patients presented with symptoms of idiopathic intracranial hypertension (IIH), and most patients were women and obese. Primary spontaneous CSF rhinorrhea may be due to IIH, and it is a rare symptom of IIH. When treating or monitoring these patients during follow-up, ICP should be controlled, and other symptoms of IIH should be noted.

Abbreviations used in this paper: BMI = body mass index; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension.

Article Information

Address correspondence to: Pinan Liu, M.D., Ph.D., Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, 6 Tiantan Xili, Chongwen District, 100050 Beijing, People's Republic of China. email: pinanliu@yahoo.com.cn.

Please include this information when citing this paper: published online April 8, 2011; DOI: 10.3171/2011.3.JNS101447.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Computed tomography scan demonstrating a fistula at the roof of the ethmoid sinus (arrow shows the bone defect).

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    Computed tomography scan showing a fistula at the lateral wall of the sphenoid sinus (arrow shows the bone defect around the foramen rotundum).

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    Magnetic resonance image showing the empty sella (arrow).

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