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CSF rhinorrhea, water drops from left nostril. MRI confirms it. Surgery the only option?

I ve been diagnosed with CSF Rhinorrhea . I have water drops coming from my left nose for a month and half now. I ve got MRI -noninvasive done which confirms the same. I want to know if surgery or further tests are possible with out entering any dye in my smipne or taking out fluid from smine to keep the pressure low. I do not have any other problem - IS surgery only option available to stop this??? Please help.
Asked On : Tue, 30 Oct 2012
Answers:  1 Views:  173
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ENT Specialist 's  Response

Thank you for your query,

1. If you have confirmed CSF rhinorrhea, the treatment remains the same, irrespective of the cause.

2. Was your CSF leak spontaneous or following a head injury? How is your sense of smell now? Is there any other cause for the leak, such as raised intra cranial tension?

3. What you describe resembles the 'Teapot' or Reservoir' Sign . Clear nasal discharge from the nose, especially on bending forward or looking down.

4. You should get the fluid collected in a sterile container and get a Beta-2 Transferrin test on the fluid, if available.

5. A simple test is the 'Handerchief Test': Normal nasal secretions contain mucus which will stain and stiffen a soft handkerchief on drying, but CSF will not.

6. If CSF leak is suspected, ideally a CT cisternography and MRI with contrast should be done. Spontaneous leaks may be multiple. Bone is not visible on MRI.

7. A spinal lumbar drain may be temporary. You may try conservative medical treatment with strict bed rest in a propped up position for 10 days. Diamox (acetazolamide) helps reduce CSF production for a couple of weeks. Small low pressure leaks may close by this treatment.

8. If you have confirmed CSF rhinorrhea, then an endoscopic repair through the nose or an open approach (craniotomy) will be possible with fat, cartilage, fascia and fibrin glue. Waiting too long may put you at a risk of meningitis which may have disastrous consequences.

Answered: Mon, 24 Dec 2012
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