[01] Guru Dutta Satyarthee, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. [02] S. Satyarthee, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

CSF rhinorrhea is a challenging task faced by Neurosurgeon in day to day surgical practice. It can be caused traumatic or spontaneous origin. Incidence of traumatic CSF rhinorrhea is much common, however most cases of early traumatic CSF rhinorrhoea respond very well to the conservative therapy. However delayed post-traumatic CSF rhinorrhoea usually warrant repair of fistula communication. Spontaneous CSF rhinorrhoea can be caused by high or low pressure leak. In the setting of low pressure CSF rhinorrhoea, fistula repair is priority, unlike in the high pressure fistula , the fistula repair and CSF diverting shunt procedure should be carried out either concurrently or Ventriculoperitoneal shunt followed by gap of few weeks interval and fistula repair. As such clear guidelines for management of high pressure CSF leak is still lacking. Author reports a 16-year-old girl from remote village having aqueductal stenosis, which developed spontaneous CSF rhinorrhoea. She underwent CSF diversion procedure. Despite the simple Ventriculo-peritoneal shunt, which were draining well, CSF leak persisted, necessitating transcranial repair of anterior cranial fossa floor, which ultimately led to stoppage of CSF rhinorrhoea.

Aqueductal Stenosis, Hydrocephalus, Spontaneous CSF Rhinorrhoea

[01] Roberts GA, Foy PM, Bolger C. Idiopathic spontaneous cerebrospinal fluid rhinorrhoea and pneumocephalus: case report and literature review. British J of Neurosurg 1996; 10: 513-517. [02] Clark D, Bullock P, Hui T, Firth J Benign intracranial hypertension: a cause of CSF rhinorrhoea. Journal of Neurolo Neurosurg Psychiatry 1994; 57: 847-849. [03] Eljamel MSM, Foy PM. Non –traumatic CSF fistulae: clinical history and management Bri J of Neurosurg 1991; 5: 275-279. [04] Mariani I, Tribole ND. Spontaneous trigemino- pontine pneumocephalus Bri J of Neurosurg 1991; 5: 199-204. [05] Schrijver I, Schievnik WI, Godfrey M, Meyer FB, Francke U. Spontaneous spinal cerebrospinal fluid leaks and minor skeletal features of Marfan syndrome: a microfibrillopathy. J Neurosurg, 2002; 96: 483-489. [06] Ommaya AK. Cerebrospinal fluid rhinorrhoea. Neurology 1964; 27: 214-216. [07] Stewart BT, Kaye AH. Delayed CSF rhinorrhoea: a case report, Aust N Z J surg 1992; 62: 818-820. [08] Klimek EH, Mc Donald RL, Deck JH. Pneumocephalus following treatment of esthesioneuroblastoma Can J Neurol Sci 1991; 18: 358-360. [09] Sckerci Z, Akalan N, Kilic, et al. Pneumocephalus at the cerebellopontine angle secondary to chronic otitis media. Clin Neurol Neurosurg 1990; 92: 155-159. [10] Locke CE The spontaneous escape of cerebrospinal fluid through the nose. Arch Neurol Psychiatry (Chicago) 1926; 15: 309-324. [11] Hudson WR, Hudhes LA. Cerebrospinal rhinorrhoea. South Med J. 1975; 68: 1520-1523.12. [12] Satyarthee GD, Mahapatra A K. Spontaneous CSF rhinorrhoea in a Dandy-Walker syndrome. Neuroscience Today. 2002; 6 (2): 121-122.