Some of the IIH patients might present only with CSF leak symptoms such as rhinorrhea, low tension headaches, or bacterial meningitis. Also, some authors have suggested that primary spontaneous CSF leaks represent a form of idiopathic intracranial hypertension. Idiopathic intracranial hypertension (IIH) is now recognized as one of the causes of spontaneous CSF leak in the neurosurgical and ENT literature. The exact pathophysiology of spontaneous CSF rhinorrhea is not always understood in some patients. Most of the CSF rhinorrhea cases develop after an iatrogenic and accidental dura matter injury, although spontaneous and nontraumatic cases have been reported. The cerebrospinal fluid (CSF) leakage from the subarachnoid space (SAS) into the paranasal sinuses and then to the nasal cavity is called CSF rhinorrhea. This has led to no recurrence and decreased hospital stay. Conclusion: The prespecified treatment algorithm with measuring the ICT at the same setting of the endoscopic repair has a better result for control of spontaneous CSF rhinorrhea. None of the patients had a recurrence during the follow-up period. 43.9% of the patients were found to have an increased ICT (≥20 cmH 2O) and underwent a permanent CSF diversion at the same setting of the endoscopic repair. The mean pre-operative ICT manometry was 17.2 ± 5.9 cmH 2O (range, 10 - 26 cmH 2O).
Results: 41 patients, 35 females and 6 males, presented with spontaneous CSF rhinorrhea with a mean BMI of 38 ± 4.16 Kg/m 2. The patient’s demographics, clinical data, comorbidities, body mass index (BMI), first time or recurrent leakage and duration of the leak were collected. Patients with a history of previous cranial or nasal surgery, trauma, skull base congenital malformations were excluded from the study. Methods: We prospectively managed patients with spontaneous CSF rhinorrhea who were admitted to our hospital between 1 st of January 2014 and 31 st of December 2017 with a prespecified treatment algorithm. Our aim was to set a management protocol for such cases according to the same setting intracranial tension (ICT). Idiopathic intracranial hypertension (IIH) is now recognized as one of the causes of spontaneous CSF leak in the neurosurgical and ENT literature. Introduction: The exact pathophysiology of spontaneous CSF rhinorrhea is not always understood in some patients.
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