• Khalid Al-Sebeih, Kostadin Karagiozov, Ahmed Elbeltagi, and Fuad Al-Qattan.
• Department of Surgery, Faculty of Medicine, Kuwait University. kalseb@qualitynet.net
• Ann Saudi Med. 2004 Nov 1; 24 (6): 453-8.

BackgroundAlthough the majority of cerebrospinal (CSF) fistulas in the anterior skull base are traumatic in nature, the minority is non-traumatic or primary. Non-traumatic CSF leak can be a diagnostic and treatment challenge.Patients And MethodsWe describe the diagnosis, modified methods of localization, and surgical repair of a series of nine patients who presented with non-traumatic CSF rhinorrhea and were managed between July 2000 and October 2002.ResultsEight patients were managed via an endoscopic approach and one patient through an intracranial approach. The RI/T2-FLAIR test was used for localization of the site of the leak. The test confirmed the site of CSF leak in 6 patients. Successful repair of CSF rhinorrhea was achieved in 7 of 8 patients with a single endoscopic procedure; one patient required two procedures after a re-leak 18 months following the first repair.ConclusionNon-traumatic CSF rhinorrhea is a relatively rare condition and occurs secondary to different etiologies. Among multiple techniques available for localization, MRI/FLAIR is effective, but requires further evaluation and polishing. In the absence of a large skull base lesion or tumor, endoscopic repair of CSF fistula carries a high success rate with a high margin of safety and low morbidity rate.

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