Diagnosis and treatment of cerebrospinal fluid rhinorrhea with intracranial hypertension

Purpose

We aimed to evaluate the impact of intracranial pressure on the prognosis of cerebrospinal fluid (CSF) rhinorrhea repair surgeries, identify critical diagnostic considerations for CSF rhinorrhea associated with intracranial hypertension, and provide insights into developing effective, individualized treatment strategies for these patients.

Methods

We analyzed the clinical data of 16 confirmed and 5 suspected cases of CSF rhinorrhea with intracranial hypertension treated at our hospital from 2015 to 2021. We documented trends in intracranial pressure before and after surgical intervention, assessed clinical manifestations, and investigated the influence of CSF shunting on patient outcomes.

Results

Among the CSF rhinorrhea patients, 8 cases experienced relapse, 18 achieved full recovery, and 3 succumbed to their conditions. All three deceased patients had severe craniocerebral trauma complicated by intracranial infections, hydrocephalus, or pneumocephalus both before and after surgery. These patients underwent multiple relapses and repeated surgical interventions. Two cases of traumatic CSF rhinorrhea with intracranial hypertension were associated with intracranial infection and hydrocephalus. Both were successfully treated with surgery following preoperative lumbar drainage. The remaining five relapsed patients (three iatrogenic and two traumatic cases) underwent CSF shunting to control intracranial pressure and were subsequently cured through additional conservative or surgical interventions. The six confirmed and five suspected cases of spontaneous CSF rhinorrhea were managed with routine lumbar drainage and continuous intracranial pressure monitoring until stabilization. All these patients were successfully treated with surgery.

Conclusion

Intracranial hypertension plays a critical role in the pathogenesis and surgical failure of CSF rhinorrhea. In cases of severe craniocerebral trauma with hydrocephalus and dilated ventricles, modifying CSF circulation before surgery is essential for effective management. Spontaneous CSF rhinorrhea strongly correlates with intracranial hypertension. Precise evaluation and appropriate management of intracranial hypertension are vital for improving patient outcomes in CSF rhinorrhea cases.