Cerebrospinal fluid rhinorrhea: pathophysiological aspects and treatment

The treatment of cerebrospinal fluid rhinorrhea is a challenge and requires a therapeutic strategy in order to reduce the risk of meningitis. The localization of the fistula is not always easy and direct surgical repair requires major operation with an outcome not always successful. In many patients, an alteration of CSF pressure and/or dynamics may be associated to the rhinorrhea, making its spontaneous or surgical closure difficult. In a series of 81 patients affected by rhinorrhea, we have studied the CSF pressure and dynamics and tried to stop the fistula by using a temporary or permanent CSF drainage. This procedure was able to cure the fistula in 54 cases, while a direct surgical repair was required in 12 patients. In 13 cases both the procedures were required. Two patients refused any treatment. These results indicate that the study of the CSF pressure and dynamics may help to understand physiopathology of the CSF rhinorrhea and that the CSF drain (temporary or permanent) can be a simple way of definitively curing the CSF fistula in the majority of patients suffering from rhinorrhea.