Spontaneous cerebrospinal fluid rhinorrhea: a clinical and anatomical study.
OBJECTIVE
Spontaneous nasal cerebrospinal fluid (CSF) fistula represents a rare clinical entity. The possible etiology and the localization of the rhinorrhea remain an ongoing clinical challenge. The purpose of this study was to evaluate the localization of spontaneous CSF fistula and to correlate it with anatomical studies.


METHODS
Retrospective clinical study, prospective anatomical study.


METHODS
Twenty-nine patients with spontaneous CSF rhinorrhea were retrospectively studied, 10 males and 19 females. Ages ranged from 10 to 92 years (mean, 50 years). In addition, 48 human skulls from newborns to adults were examined for the postnatal development of the anterior and middle cranial fossa.


RESULTS
In our study isolated cribriform plate defects were found in four patients. The lateral lamina of the ethmoid bone showed defects in three patients. In nine patients the bony defect could be found in the region of the fovea ethmoidalis. The bony defect between the extra- and intracranial space was found in the lateral recess of the sphenoid sinus in eight patients. Five patients had special sites (e.g., supraorbital recess and frontal recess).


CONCLUSIONS
This study supports the theory that bony dehiscence in the lateral lamina of the ethmoid bone can be congenital and can also be spontaneously acquired later. The bony dehiscence in the lateral wall of the sphenoid sinus can only develop during pneumatization.
Tóth
Miklós
M
Department of Otorhinolaryngology, Johannes Gutenberg University Medical School, Mainz, Germany. toth@hno.klinik.uni-mainz.de
Selivanova
Oxana
O
Schaefer
Steven
S
Mann
Wolf
W
D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000151:congenital / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D002648:Child; D035262:Cranial Fossa, Anterior / Q000473:pathology*; D035301:Cranial Fossa, Middle / Q000473:pathology*; D005004:Ethmoid Bone / Q000473:pathology / Q000601:surgery; D005005:Ethmoid Sinus / Q000473:pathology / Q000601:surgery; D005260:Female; D005626:Frontal Sinus / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013100:Sphenoid Bone / Q000473:pathology / Q000601:surgery; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult