Traumatic CSF rhinorrhea associated with COVID-19 testing: a case series and systematic review

Area of Science:

• Neurology
• Otolaryngology
• Infectious Diseases

Background:

• Nasopharyngeal swabbing for SARS-CoV-2 detection can lead to traumatic anterior skull base CSF leaks.
• This study presents the largest case series to date on this complication, supplemented by a systematic literature review.

Purpose of the Study:

• To analyze the presentation, risk factors, and management of CSF leaks following nasopharyngeal swabbing for COVID-19.
• To clarify the clinical course and outcomes of these leaks, including the impact of meningitis.

Main Methods:

• Retrospective multi-institutional case-series of traumatic anterior skull base CSF leaks with a history of COVID-19 swab.
• Systematic literature review of relevant databases.

Main Results:

• Thirty-four patients with CSF leaks post-swabbing were identified; women were more affected.
• Common leak sites included the cribriform plate (52.9%). Four patients (11.8%) developed meningitis.
• Median time to leak detection was 4 weeks. Leaks were longer in patients with meningitis. Endoscopic repair was successful in 92.9% of cases.

Conclusions:

• Diagnostic nasopharyngeal swabbing can cause anterior skull base CSF leaks.
• Timely endoscopic endonasal surgical repair is the recommended management for these CSF leaks.