Spontaneous cerebrospinal fluid (CSF) rhinorrhea occurs in the absence of traumatic, tumor, or iatrogenic disorder, which usually makes up about 3–4% of CSF leaks ( Lopatin et al., 2003 Shah et al., 2017). Ten months later, the patient showed a significant improvement in terms of his herniated tonsil and cessation of CSF rhinorrhea. The patient showed a prompt resolution of CSF leak. The patient still had case of CSF rhinorrhea, and subsequently underwent lumboperitoneal shunt (LPS) for treatment of ICP. Post-operative CSF pressure measurement demonstrated elevated ICP. Endoscopic third ventriculostomy (ETV) was performed for the patient with obstructive hydrocephalus. Cine-MRI revealed the flow of CSF was obstructed at the aqueduct and the outlet of the fourth ventricle. Computed tomography (CT) and magnetic resonance images (MRI) showed signs of CSF in the left sphenoidal sinus, meningocele in the left frontal sinus, empty sella, hydrocephalus, and Chiari I malformation (CIM). The onset of his symptoms occurred in 1 week in the form of a persistent clear left nostril rhinorrhea. We describe a 25-year-old man without a history of head injury, tumor, or obesity.

However, the recurrence rate of CSF leaks after the endoscopic endonasal repair of skull base defects due to ICP is usually high.

Endoscopic endonasal repair is typically warranted for CSF rhinorrhea. Spontaneous CSF rhinorrhea is associated with elevated intracranial pressure (ICP), which is rarely stopped without surgical intervention. Spontaneous cerebrospinal fluid (CSF) rhinorrhea represents an important clinical entity that is being observed with increasing prevalence, ranging from 14 to 55%. 4School of Medicine, Southeast University, Nanjing, China.3Arkansas Colleges of Health Education, Fort Smith, AR, United States.2School of Medicine, Nanjing Medical University, Nanjing, China.

1Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.

Chao Tang 1†, Junhao Zhu 2†, Kaiyang Feng 3, Jin Yang 2, Zixiang Cong 1, Xiangming Cai 4, Liang Qiao 1* and Chiyuan Ma 1*

Spontaneous cerebrospinal fluid leak