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CSF rhinorrhea
Leakage of CSF in to the nose
Clear /
mixed with blood (in a/c head injuries)
Etiology
Trauma (commonest)
Accidental
Surgical ( FESS, nasal polypectomy, trans sphenoidal
hypophysectomy,skull base surgery)
Site of leakage
1. anterior cranial fossa
a) Cribriform plate
b) Roof of ethmoid
c) Frontal sinus
Diagnosis
h/o clear watery discharge on bending head/ straining
sudden gush cant be sniffed back
Reservoir sign :
When rising in morning csf collected in sinuses on bending
head
Laboratory tests
B2 transferrin
Sensitive & specific
Only few drops of csf is needed
Perilymph & aqueous also contains it but not in nasal discharge
Glucose testing
> 30 mg/dl in csf
<10 mg/dl in nasal discharge
Localisation of site
High resolution CT scan
Coronal & axial cuts at 1-2 mm } bony defects
Axial } frontal & sphenoid sinus
MRI
T2 weighted image Site of leak
Active CSF leak is needed
Non invasive
Treatment
Conservative
Bed rest
Elevating the head
Stool softeners
Avoidance of node blowing, sneezing & straining
Prophylatic abx } meningitis
Acetazolamide } formn of CSF
Surgical repair
Neurosurgical intra cranial approach
Extra dural approach
External ethmoidectomy } cribriform plate
Trans septal sphenoidal approach } sphenoid
Osteoplastic flap } frontal
Cribriform plate
Lateral lamina close to anterior ethmoid a
Roof of ethmoid
Frontal sinus leak
Sphenoid sinus
CT cisternogram
Localise the lesion
Intrathecal injection of iohexol & CT
Where B2 transferrin cant be done