• Sheikh Asad, Jens Peters-Willke, Warwick Brennan, and Saima Asad.
• Departments of Neurosurgery and ENT, Royal Hobart Hospital Tasmania, Hobart, Australia. Electronic address: dr.sheikhasad@gmail.com.
• World Neurosurg. 2017 Oct 1; 106: 1052.e1-1052.e4.

BackgroundPrimary spontaneous cerebrospinal fluid (CSF) rhinorrhea due to clival defect is an extremely rare presentation, and only 6 cases have been reported in the literature so far17.Case DescriptionWe present a unique case of a 64-year-old woman who presented with a 2-year history of ongoing CSF rhinorrhea. She had similar episode at the age of 40 years and suffered from meningitis. She underwent magnetic resonance imaging, computed tomography cisternogram, as well as computed tomography of the brain, which showed clival defect with CSF leak into the sphenoid sinus. She underwent transsphenoidal repair of the clival defect with concurrent lumbar drain insertion for CSF drainage. She returned a few months later with recurrent CSF rhinorrhea and meningitis. She was administered broad-spectrum antibiotics and underwent septal reconstruction of clival defect.ConclusionsTimely endoscopic transnasal, transsphenoidal repair of CSF leaks is the gold standard practice and could prevent devastating complications including repeated episodes of meningitis.Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

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