Cerebrospinal Fluid (CSF) Rhinorrhea: Leakage of Cerebrospinal Fluid from the Nose

Rhinorrhea refers to the excessive flow of fluid from the nose. It can be caused by different factors such as a cold, allergies, infections, or cerebrospinal fluid leakage (CSF rhinorrhea). Cerebrospinal fluid (CSF) is a vital fluid that surrounds, protects, and nourishes the brain and spinal cord. CSF helps remove metabolic waste and plays a role in fighting infections.

CSF rhinorrhea is a condition characterized by the flow of clear fluid, similar to water, from the nose. Sometimes, even simple actions like straining or lifting heavy objects can trigger it. Uncontrolled CSF leakage can lead to serious health issues, including meningitis.

Common causes of CSF rhinorrhea include:

• Idiopathic (spontaneous) causes
• Head trauma (falls, traffic accidents, blows)
• Post-surgical complications (leakage after brain or nasal surgery)
• Congenital structural weaknesses (thin or weak skull base)
• Brain or skull base tumors

Symptoms of CSF Rhinorrhea

• Unilateral, continuous, clear fluid flow from the nose
• Increased fluid flow when bending forward
• Headache
• Vision problems and light sensitivity
• Stiff neck and symptoms of meningitis

Diagnostic Methods

Methods used to diagnose CSF rhinorrhea:

• Beta-2 transferrin test (accurately detects the presence of CSF fluid)
• CT (Computed Tomography) (shows skull base fractures)
• MR (Magnetic Resonance) and MR cisternography (identifies the source of leakage)

Treatment Methods

Treatment for CSF rhinorrhea depends on the source of the leak:

1. Spontaneous recovery: Mild cases may improve with rest, keeping the head elevated, and fluid intake.
2. Medication: Antibiotics may be prescribed to prevent infection.
3. Surgical intervention: Surgery is required if leakage persists or if the infection risk is high.

Endoscopic CSF Rhinorrhea Repair

A minimally invasive method called endoscopic CSF repair is used to close the leak by entering through the nose.

Surgical Process

• The location of the leak is identified using imaging (CT/MR/MR Cisternography).
• The leak area is exposed using an endoscope.
• The defect is sealed with fascia, mucosal flap, or fat tissue.
• Recovery is supported with tampon or lumbar drainage.

Post-surgery Care Instructions

• Follow-up is required in the hospital for 1-3 days.
• Avoid blowing the nose and heavy physical activity during the first weeks.
• The success rate is high (90-95%), but if untreated, there is a risk of meningitis.

Prevention and Protection

• Sleeping with the head elevated and avoiding bending forward can reduce leakage.
• Avoid blowing the nose or straining, as it can increase pressure and worsen the leakage.
• Drinking plenty of fluids can help maintain the balance of cerebrospinal fluid.
• Be alert to signs of infection, such as fever, stiff neck, and confusion, as they are critical.

Conclusion

Unilateral, clear nasal discharge should not be taken lightly. When these symptoms are noticed, they should not be ignored, and a specialist should be consulted. Early diagnosis and appropriate treatment can prevent serious complications.