Spontaneous Clival Leaks and their management

Abstract

Introduction: Cerebrospinal spinal fluid (CSF) leaks through the nasal cavity occurrence has a rising trend, of which primary spontaneous leak is 6%-40% of all the CSF leaks. The most common site of CSF leak is Ethmoid roof where the bone is thinner in the entire skull base. Clivus being the hard bone, is a rare site for spontaneous leak. We present a case series from a single quaternary care center of this rare occurrence and study its reason and management strategy. Materials and Methods: A retrospective surgical audit over a period of 10 years of all patients diagnosed with CSF rhinorrhea was done .A PubMed search was conducted with keywords of CSF leak, CSF rhinorrhea, spontaneous CSF rhinorrhea, clival leak, clivus to identify the literature and these articles were compiled and their management reviewed. Results and Analysis: A total of 100 patients underwent surgical management for spontaneous CSF leak of which there were 5 patients who had spontaneous CSF rhinorrhea from the Clivus. There were 4 female patients, 4 patients had high BMI. The most common site of leak was midclivus annd surgical technique employed was multilayer dural plasty with a nasoseptal flap and measures were taken to reduce the intracranial pressure intra operatively and post operatively Conclusion: Spontaneous clival leak is a rare entity with mid and lower clivus being the common site. A combined approach by ENT and Neurosurgeons results in best outcome for the patients.