Pseudo-cerebrospinal fluid rhinorrhea after skull base surgery

Area of Science:

• Neurosurgery
• Otolaryngology
• Neurology

Background:

• Petroclival meningiomas are tumors located at the skull base.
• Surgical resection often requires complex approaches, such as the anterior transpetrosal approach.
• Division of cranial nerves, including the greater superficial petrosal nerve, can occur during these procedures.

Observation:

• A patient developed clear fluid leakage from the right nostril post-operatively.
• The leakage occurred intermittently, specifically when the ambient room temperature increased.
• This symptom emerged 14 days after the surgical resection of a left petroclival meningioma.

Findings:

• The observed symptom is consistent with pseudo-cerebrospinal fluid (CSF) rhinorrhea.
• The division of the greater superficial petrosal nerve is a potential cause.
• Parasympathetic hypersensitivity resulting from nerve division is hypothesized as the underlying mechanism.

Implications:

• This case highlights a potential, albeit rare, complication following petroclival meningioma surgery.
• Understanding the link between greater superficial petrosal nerve division and pseudo-CSF rhinorrhea is crucial for diagnosis.
• Further research may explore management strategies for this specific type of rhinorrhea.