title: Bilateral, spontaneous cerebrospinal fluid rhinorrhoea: endoscopic, uninasal, trans-septal approach for simultaneous closure.
abstract: BACKGROUND
  Bilateral, spontaneous cerebrospinal fluid rhinorrhoea is extremely rare, with only one previous case report (this patient developed contralateral cerebrospinal fluid leakage four years after successful endoscopic repair). We present the first English-language report of simultaneous, bilateral, spontaneous cerebrospinal fluid rhinorrhoea.
  
  
  OBJECTIVE
  To recommend a simple alternative endoscopic technique for simultaneous closure of bilateral, spontaneous cerebrospinal fluid rhinorrhoea.
  
  
  METHODS
  A 47-year-old woman presented with recent onset of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, a recent history suggestive of meningitis, and a past history of pneumococcal meningitis. Bony defects on both sides of the cribriform plate were closed endoscopically in the same anaesthetic session, via a uninasal, trans-septal approach, enabling both leakage sites to be sealed simultaneously.
  
  
  CONCLUSIONS
  In cases of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, uninasal, trans-septal endoscopic repair is a simple and effective technique for simultaneous closure of cerebrospinal fluid leakage.
authors.affiliation: Department of ENT, Head and Neck Surgery, Speech and Hearing, Christian Medical College, Vellore, India. ent2@cmcvellore.ac.in
authors.forename: M
authors.initials: M
authors.lastname: Kurien
authors.forename: G A
authors.initials: GA
authors.lastname: Mathew
authors.forename: S L
authors.initials: SL
authors.lastname: Abraham
authors.forename: A
authors.initials: A
authors.lastname: Irodi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004724:Endoscopy; D005004:Ethmoid Bone / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009296:Nasal Cavity; D059747:Nasal Surgical Procedures / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D035583:Rare Diseases; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone