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CSF rhinorrhea
CSF rhinorrhea 
• Leakage of CSF in to the nose 
• Clear / 
• mixed with blood (in a/c head injuries)
Etiology 
• Trauma (commonest) 
• Accidental 
• Surgical ( FESS, nasal polypectomy, trans sphenoidal hypophysectomy,skull ...
Site of leakage 
1. anterior cranial fossa 
a) Cribriform plate 
b) Roof of ethmoid 
c) Frontal sinus 
2. Middle cranial f...
Diagnosis 
• h/o clear watery discharge on bending head/ straining 
• sudden gush can’t be sniffed back 
• Reservoir sign ...
• After a head trauma 
• Double target sign when collected on a piece of filter paper with central 
blood & peripheral lli...
• Nasal endoscopy  localize site of CSF leak 
• Otoscopic /microscopic examination of ear } CSF otorrhinorhea
Laboratory tests 
• B2 transferrin 
• Sensitive & specific 
• Only few drops of csf is needed 
• Perilymph & aqueous also ...
Localisation of site 
• High resolution CT scan 
• Coronal & axial cuts at 1-2 mm } bony defects 
• Axial } frontal & sphe...
Treatment 
• Conservative 
• Bed rest 
• Elevating the head 
• Stool softeners 
• Avoidance of node blowing, sneezing & st...
Surgical repair 
• Neurosurgical intra cranial approach 
• Extra dural approach 
• External ethmoidectomy } cribriform pla...
• Trans nasal endoscopic approach 
• With endoscope 
• Site of leak 
1. Cribriform plate 
2. Lateral lamina close to anter...
• Intrathecal fluorescein study 
• Pre operatively }to dx site 
• Intra operatively for repair 
• Invasive 
• 0.25-0.5 ml ...
Csf rhinorrhea ppt
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Csf rhinorrhea ppt

complications causes ent images meningitis diagnosis Reservoir sign :
Double target sign differece between nasal secretion B2 transferrin
Localisation treatment CT MRI conservative surgical

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Csf rhinorrhea ppt

  1. 1. CSF rhinorrhea
  2. 2. CSF rhinorrhea • Leakage of CSF in to the nose • Clear / • mixed with blood (in a/c head injuries)
  3. 3. Etiology • Trauma (commonest) • Accidental • Surgical ( FESS, nasal polypectomy, trans sphenoidal hypophysectomy,skull base surgery) • Neoplasms (benign/malignant) invading skull base • Inflammations (mucocele of sinuses ,sinu nasal polyposis, fungal infections of sinusitis & osteomyelitis erode the bone & dura) • Congenital (meningocele,meningoencephalocele & glioma with skull base defect) • Idiopathic
  4. 4. Site of leakage 1. anterior cranial fossa a) Cribriform plate b) Roof of ethmoid c) Frontal sinus 2. Middle cranial fossa  1. injuries to sphenoid sinus 2. In # of temporal bone CSF ME ET nose (CSF otorhinorhea)
  5. 5. Diagnosis • h/o clear watery discharge on bending head/ straining • sudden gush can’t be sniffed back • Reservoir sign : • When rising in morning csf collected in sinuses on bending head
  6. 6. • After a head trauma • Double target sign when collected on a piece of filter paper with central blood & peripheral llighter halo
  7. 7. • Nasal endoscopy  localize site of CSF leak • Otoscopic /microscopic examination of ear } CSF otorrhinorhea
  8. 8. Laboratory tests • B2 transferrin • Sensitive & specific • Only few drops of csf is needed • Perilymph & aqueous also contains it but not in nasal discharge • Beta trace protein • Specific for CSF • Glucose testing • > 30 mg/dl in csf • <10 mg/dl in nasal discharge
  9. 9. Localisation of site • High resolution CT scan • Coronal & axial cuts at 1-2 mm } bony defects • Axial } frontal & sphenoid sinus • MRI • T2 weighted image Site of leak • Active CSF leak is needed • Non invasive
  10. 10. Treatment • Conservative • Bed rest • Elevating the head • Stool softeners • Avoidance of node blowing, sneezing & straining • Prophylatic abx } meningitis • Acetazolamide } ↓ formn of CSF
  11. 11. Surgical repair • Neurosurgical intra cranial approach • Extra dural approach • External ethmoidectomy } cribriform plate • Trans septal sphenoidal approach } sphenoid • Osteoplastic flap } frontal
  12. 12. • Trans nasal endoscopic approach • With endoscope • Site of leak 1. Cribriform plate 2. Lateral lamina close to anterior ethmoid a 3. Roof of ethmoid 4. Frontal sinus leak 5. Sphenoid sinus • Preparation of graft site • Underlay placement of graft extra durally (mucosa for small defect….. Septal cartilage if>2cm) • Surgical & gelfoam strengthen • Lumbar drain if CSF pressure is high • abx
  13. 13. • Intrathecal fluorescein study • Pre operatively }to dx site • Intra operatively for repair • Invasive • 0.25-0.5 ml of 5% fluorescein mixed with patients own CSF is injected & pt lies in 10 ’ head down position for some time dye ca be detected intranasally with the help of endoscope……….appears bright yellow but when seen with blue filter } flurescent green • Localise the lesion • CT cisternogram • Localise the lesion • Intrathecal injection of iohexol & CT • Where B2 transferrin can’t be done

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