Spontaneous Cerebrospinal Fluid Leak at the Clivus: Report of 2 Cases and Review of the Literature

Seyed Ali Mousavinejad1,2*

1 Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Iran 2 Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Iran

^*Correspondance to: Seyed Ali Mousavinejad 

 PDF  Full Text DOI: 10.25107/2474-1647.3044

Abstract

Background: Spontaneous cerebrospinal fluid leaks comprise 5% to 10% of all CSF rhinorrhea. Generally, CSF rhinorrhea occur at cribriform plate, sella, sphenoid sinus and ethmoid air. Primary CSF rhinorrhea from clival defect is extremely rare. We describe two cases of spontaneous CSF rhinorrhea through the clivus defect and review the literature. Case Presentation: The first patient was a 36-year-old female admitted to our department because of clear watery discharge from the right nostril of 3 weeks which aggravated in prone position. The second case was a 57-year-old man referred to our department with the complaint of intermittent rhinorrhea starting 6 months before surgery. He had a past history of bacterial meningitis few months before stating the rhinorrhea which was treated in another center. In both cases, testing of the fluid for beta-2 transferrin was positive. Magnetic resonance imaging and computed tomography cistern gram showed CSF leak through clivus into the sphenoid sinus. In both patients defect was repaired with abdominal fat, reinforced by fascia lata and naso septal flap via ?two nostrils - four hands? endoscopic transnasal technique. Conclusion: At times, the exact pathophysiology of CSF clival fistulais debated, however a combination of anatomical and functional factors play a role in the occurrence of this rare phenomenon. To date, only 16 cases are reported, and the current study reported a group of two consecutive cases. To date, endoscopic transnasal approach is the best therapeutic option to repair midline skull base defect such as the current cases.

Keywords

Spontaneous cerebrospinal fluid leak; Rhinorrhea; Clivus; Meningitis; Endoscopic endonasal approach

Cite the article

Mousavinejad SA. Spontaneous Cerebrospinal Fluid Leak at the Clivus: Report of 2 Cases and Review of the Literature. Clin Surg. 2021; 6: 3044..