Management of recurrent CSF rhinorrhea of the middle and posterior fossa

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Abstract
Patients [39] with CSF leaks originating from the middle or posterior fossa were reviewed. The usefulness of preoperative investigative procedures, including cisternal radionuclide scanning and the deliberate increase of intracranial pressure was evaluated. The results in this series emphasize the important role that abnormal CSF dynamics play in the recurrence of problematic cases of rhinorrhea or otorrhea. The following guidelines are recommended on the basis of recent experience: if hydrocephalus is present, if the cisternogram is abnormal or if the CSF leak is intermittent and slight, the initial treatment should be insertion of a lumboperitoneal shunt; if the leak is localized in the sellar or parasellar area, a transsphenoidal approach to obliterate the leak is advised; if the CSF leak originates through a dural opening into the middle ear, an intracranial repair is indicated.