Primary spontaneous cerebrospinal fluid leaks located at the clivus

Area of Science:

• Neurosurgery
• Otolaryngology
• Radiology

Background:

• Transclival meningoceles and primary spontaneous cerebrospinal fluid (CSF) leaks at the clivus are exceptionally rare neurological conditions.
• Few cases have been documented in medical literature, making extensive study difficult.

Purpose of the Study:

• To report on six cases of transclival primary spontaneous CSF leaks.
• To analyze presenting symptoms, defect characteristics, surgical approaches, and outcomes.
• To emphasize the significance of identifying and managing increased intracranial pressure (ICP).

Main Methods:

• A retrospective case study was conducted on six patients treated for sinonasal CSF leaks at the clivus between 1997 and 2009.
• Data reviewed included symptoms, defect details, surgical techniques (transnasal vs. transnasal transseptal), and complications.
• Follow-up data was collected to assess recurrence rates.

Main Results:

• All six CSF leaks were located in the upper central clivus.
• Two patients presented with signs of increased ICP (arachnoid pits and/or empty sella).
• A 100% closure rate was achieved regardless of the multilayer reconstruction technique used (nonvascularized graft or nasoseptal flap).
• Mean follow-up was 10.3 years with no observed recurrences.

Conclusions:

• Spontaneous CSF rhinorrhea at the clivus is a rare condition, with this series representing the largest reported group to date.
• Both transnasal and transnasal transseptal approaches with multilayer reconstruction are effective for defect closure.
• Prompt identification and management of increased ICP are crucial for successful treatment outcomes.