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Spontaneous Clival Leaks and Their Management
Katti Blessi Sara1, Garima Upreti2, Habie Thomas1
1Department of Otorhinolaryngology, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
Journal of Neurological Surgery. Part B, Skull Base
|March 19, 2025
Summary
Spontaneous cerebrospinal fluid (CSF) leaks from the clivus are rare but occur. A combined ENT and neurosurgery approach with multilayer dural plasty and intracranial pressure reduction offers the best outcomes for these clival leaks.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Cerebrospinal fluid (CSF) leaks through the nasal cavity are increasing.
- Primary spontaneous CSF leaks account for 6-40% of all CSF leaks.
- The ethmoid roof is the most common site, while spontaneous clival leaks are rare.
Purpose of the Study:
- To present a case series of rare spontaneous CSF leaks from the clivus.
- To investigate the reasons behind spontaneous clival leaks.
- To evaluate management strategies for clival CSF rhinorrhea.
Main Methods:
- Retrospective surgical audit of 100 patients with spontaneous CSF leak over 10 years.
- Literature review of PubMed using keywords: CSF leak, CSF rhinorrhea, spontaneous CSF rhinorrhea, clival leak, clivus.
- Analysis of patient demographics, leak site, and surgical management.
Main Results:
- Five patients (5%) presented with spontaneous CSF rhinorrhea from the clivus.
- The most common leak site was the mid-clivus.
- Multilayer dural plasty with a nasoseptal flap and intracranial pressure reduction were employed.
Conclusions:
- Spontaneous clival CSF leak is a rare condition, often originating from the mid or lower clivus.
- A combined surgical approach by ENT and neurosurgeons yields optimal patient outcomes.
- Management involves multilayer dural repair and intracranial pressure control.
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