Clinical characteristics and surgical treatments for spontaneous cerebrospinal fluid rhinorrhea
Objective To compare clinical data,management,and outcomes of spontaneous and nonspontaneous cerebrospinal fluid(CSF)rhinorrhea to identify effective treatment strategies.Methods Patients diagnosed with CSF rhinorrhea from January 2010 to December 2021 were included and divided into spontaneous and nonspontaneous CSF rhinorrhea groups according to etiology;demographics,imaging results,treatment strategies,reconstruction methods,and peri-operative complications were compared.Results 41 patients with spontaneous and 83 with nonspontaneous CSF rhinorrhea were included.Spontaneous CSF rhinorrhea was frequent in older(P=0.019)women(P=0.001)with hypertension(P=0.011)and patients with higher body mass index(P=0.024),while the binary logistic regression analysis showed that only higher body mass index is an independent risk factor for spontaneous CSF rhinorrhea.Lateral sphenoidal recess(P=0.001)and olfactory fossa(P=0.019)defects were significantly associated with spontaneous CSF rhinorrhea.Endoscopic surgeries were performed on 40 patients in the spontaneous group:16 patients in the nonspontaneous group required an auxiliary external approach(P=0.002).The external approach was commonly performed for traumatic CSF leaks.Vascularized intranasal flaps were typically used(39/40 patients)for spontaneous CSF leaks.Various flap combinations facilitated skull base repair in complex CSF leaks.No significant difference in success rate was identified between groups.During the follow-up period,no recurrence occurred.Conclusions Leaks in the olfactory fossa and lateral sphenoidal recess were more common in spontaneous CSF rhinorrhea.Endoscopic surgery using vascular pedicled flaps achieved good results.
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