Clinical characteristics and surgical outcomes between traumatic and nontraumatic cerebrospinal fluid rhinorrhea

The aim of this study is to compare the clinical characteristics and surgical outcomes of patients with traumatic and nontraumatic cerebrospinal fluid (CSF) rhinorrhea.

CSF rhinorrhea patients admitted between January 2007 and December 2022 were recruited and categorized into traumatic and nontraumatic groups. The clinical characteristics and surgical outcomes of the two groups were compared.

A total of 94 patients with traumatic and 49 patients with nontraumatic CSF rhinorrhea were included. The prevalence of meningitis was significantly higher in traumatic CSF rhinorrhea patients (p = 0.012). Multifocal defects were more frequent in the traumatic group, while sphenoidal defects were significantly correlated with nontraumatic CSF rhinorrhea. Frontal defects were commonly identified in CSF rhinorrhea patients with meningitis than in those without, though no statistical significance was reported. Multivariate logistic regression revealed that male sex, iatrogenic traumatic CSF leak, and pneumonitis are independent factors for development of meningitis. An endoscopic approach combined with an external incision was performed in one patient and 24 patients in nontraumatic and traumatic groups, respectively (p = 0.001). Combined vascularized grafts were more commonly used in patients with traumatic CSF rhinorrhea (p < 0.05). No statistical difference in the success rate (100% vs. 97.9%) was documented between the two groups.

Multifocal defects and meningitis were more prevalent in traumatic CSF rhinorrhea patients, leading to increased complexity in treatment management. Iatrogenic rather than accidental traumatic CSF rhinorrhea is an independent risk factor for development of meningitis. The endoscopic combined coronal extradural approach, in conjunction with various vascularized flaps, can effectively supplement skull base reconstruction, especially for complex traumatic CSF rhinorrhea.