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.