CSF Rhinorrhea

CSF Rhinorrhea

CSF rhinorrhea is the drainage of the fluid which surrounds the brain into the nose (CSF =cerebral spinal fluid + rhinorrhea = fluid draining from the nose). The choroid plexus of lateral ventricles of the brain produces approximately 800mililiters of cerebral spinal fluid daily. This clear fluid leaves the brain through the third ventricle to the fourth ventricle, and then into the subarachnoid space that surrounds the brain and spinal cord. The CSF is absorbed by a highly specialized finger-like extension of the arachnoidnoidal membrane surrounding the brain, known as the arachnoid villi. This so called "brain fluid" has the important functions of cushioning the brain, maintaining pressure within the eye, and cleansing the central nervous system much like the lymphatic system serves the same function in the rest of the body.

A breach in dura (the periosteal or nutrient membrane lining the inside of the skull) over or adjacent to the nose, sinuses or ear can provide a pathway for CSF to drain from the subarachnoid space into the nose. In such cases, an individual may first become aware of this serious event by the drainage of clear fluid from the nose or the perception of a salty fluid draining from the nose into the throat. CSF rhinorrhea can be the result of trauma to head, nasal or ear surgery or occur spontaneously.

Patients may have CSF rhinorrhea for years without having any undo consequences. Others may develop bacterial meningitis within days of the onset of the rhinorrhea because in both situations an open communication exists between the brain cavity and the non-sterile nose.

CSF rhinorrhea requires medical attention and any change in the individual's level of consciousness, fever, chills or stiff neck implies meningitis. As bacterial meningitis can be fatal and survival is dependent on rapid treatment, such inflicted individuals must seek immediate medical care. In doing so, communicating a history of CSF will assist the treating physicians in arriving at the right diagnosis and appropriate treatment. Fortunately, most clear drainage from the nose is not CSF and often reflects such conditions as allergy.

Surgical Treatment

The surgical treatment of CSF rhinorrhea has evolved from purely an external procedure utilizing a craniotomy to visualize the floor of the anterior or middle cranial fossa to a range of intranasal endoscopic, external ethmoidectomy, middle ear and variations of craniotomy approaches.