Spontaneous Cerebrospinal Fluid Leak at the Clivus: Two Case Reports and Literature Review Volume 5 - Issue 1

Mohammad Samadian¹, Seyed Ali Mousavinejad¹*, Hamid Borghei-Razavi², Guive sharifi¹, Kaveh Ebrahimzadeh¹, Kristen Almagro² and Omidvar Rezaei¹

• ¹Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
• ²Department of Neurosurgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, Florida,USA

Received: December 02, 2020;   Published:December 11, 2020

Corresponding author: Seyed Ali Mousavinejad, Assistant professor of neurosurgery, Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: 10.32474/OJNBD.2020.05.000201

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Abstract

Introduction: Spontaneous or non-traumatic cerebrospinal fluid leaks comprise 5–10% 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 herein describe two cases of spontaneous CSF rhinorrhea through the clivus repaired with endoscopic endonasal trans sphenoid approach. Moreover, we collected evidence in the literature regarding potential etiology, symptom and treatment (which occurred in the case reported).

Background: Spontaneous cerebrospinal fluid leaks comprise 5–10% 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 Description: 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 month 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 cisternogram 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 trans nasal technique.

Conclusion: At times, the exact pathophysiology of CSF clival fistula is 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 trans nasal 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

Abstract| Introduction| Case 1| Case 2| Discussion| Conclusion| References|