title: A case of spontaneous cerebrospinal fluid rhinorrhea: Accurate detection of the leak point by magnetic resonance cisternography.
abstract: BACKGROUND
  Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a rare entity. The accurate preoperative localization of the leak point is essential for planning surgical treatment, but is sometimes difficult. To localize the leak point, magnetic resonance cisternography (MRC) is the method of choice, but its effectiveness remains unclear.
  
  
  METHODS
  A 34-year-old mildly obese female experienced spontaneous CSF rhinorrhea after an attack of bronchial asthma. High-resolution computed tomography (CT) failed to reveal the leak point, while MRC demonstrated an arachnoid herniation at the olfactory cleft. The patient underwent endoscopic endonasal repair of the CSF leak with success. There has been no recurrence of CSF rhinorrhea for 14 months after surgery followed by the administration of acetazolamide.
  
  
  CONCLUSIONS
  We report a rare case of spontaneous CSF rhinorrhea associated with benign intracranial hypertension, in which the leak point was successfully detected by MRC. The CSF leak was completely repaired by minimally invasive endoscopic endonasal surgery. MRC may be a reliable method for detecting CSF leak points.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Akutsu
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Shuho
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ishikawa
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
keywords: Benign intracranial hypertension; endoscopic endonasal surgery; leak point; magnetic resonance cisternography; spontaneous cerebrospinal fluid rhinorrhea