Septal cartilage plug technique in spontaneous cerebrospinal fluid rhinorrhea postoperatively diagnosed with partial...

The otolaryngologist should consider empty sella syndrome for diagnostic guidance when evaluating patients with nontraumatic spontaneous cerebrospinal fluid (CSF) rhinorrhea. The radiographic finding of empty sella is frequently reported in patients with benign intracranial hypertension (BIH). Patients who have a spontaneous CSF leak in the absence of florid symptoms of BIH may have a disrupted pattern of CSF flow, and because they are actively leaking CSF before surgical repair, they may be at risk for developing elevated intracranial pressure and BIH after the CSF leaks have been successfully closed. We describe a patient with CSF rhinorrhea who developed headache, papilledema, and visual disturbance after surgical repair of the CSF leak. The leak was repaired by the placement of a septal cartilage plug with a free mucosal suture graft. This technique provides fundamental biomechanical stability, reduces the complexity of the multilayer packing method, and promotes an effective seal.