Traumatic, Spontaneous and Postoperative CSF Rhinorrhea

  • F. Loew
  • B. Pertuiset
  • E. E. Chaumier
  • H. Jaksche
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 11)


The paper is based on the experiences which have been collected and analyzed from a total of 237 cases in the Neurosurgical Departments at the University Clinics La Pitié, Paris, and Homburg/Saar. The senior authors are the Heads of these Departments. Both Departments have different traditions according to the different history of French and German neurosurgery. As might be expected the senior authors did not agree on all points. The divergencies of opinions and policies have not been concealed but considered important and openly discussed in our paper in order to give an as large a view as possible. In the end we feel that with regard to rhinorrhea the old proverb remains true, more than one road leads to Rome.


Sphenoidal Sinus Frontal Sinus Olfactory Nerve Cribriform Plate Transsphenoidal Approach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Andrioli, G. C, Ruberti, R., 1966: La rinoliquorrea spontanea. Chir. Ital. 18, 383–398.PubMedGoogle Scholar
  2. 2.
    Bergstrand, G., Bergström, M., Eriksen, L., Edner, G., Widen, L., 1982: Positron emission tomography with 68Gy-EDTA in the diagnosis and localization of CSF fistulas. J. Comp. Assist. Tomogr. 6, 320–324.CrossRefGoogle Scholar
  3. 3.
    Brawley, B. W., Kelly, W, A., 1967: Treatment of basal skull fractures with and without cerebrospinal fluid fistulae. J. Neurosurg. 26, 57–61.PubMedCrossRefGoogle Scholar
  4. 4.
    Coleman, C, Trolard, C, 1974: The surgical treatment of spontaneous cerebrospinal rhinorrhea. Ann. Surg. 125, 718–728.CrossRefGoogle Scholar
  5. 5.
    Cooper, P. R., 1982: Skull fracture and traumatic cerebro-spinal fluid fistulas in head injury (Copper, P. R., ed.), pp. 65–82. Baltimore-London: Williams and Wilkins.Google Scholar
  6. 6.
    Dandy, W. E., 1926: Pneumocephalus (intracranial pneumatocele or aerocele). Arch. Surg. 12, 949–982.Google Scholar
  7. 7.
    Dandy, W. E., 1944: Treatment of rhinorrhea and otorrhea. Arch. Surg. 49, 75–85.Google Scholar
  8. 8.
    Danoff, D., Serbu, J., French, L., 1966: Encephalocele extending into the sphenoid sinus. Report of a case. J. Neurosurg. 24, 684–686.PubMedCrossRefGoogle Scholar
  9. 9.
    Di Chiro, G., Reames, P. M., 1964: Isotopic localization of cranionasal cerebrospinal fluid leaks. J. Nucl. Med. 5, 376.Google Scholar
  10. 10.
    Di Chiro, G., Reames, P. M., Matthews, W. B., Jr., 1964: RISA-ventricu-lography and RISA-cisternography. Neurology 14, 185–191.Google Scholar
  11. 11.
    Di Chiro, G., Grove, A. S., Jr., 1966: Evaluation of surgical and spontaneous cerebrospinal fluid shunts by isotope scanning. J. Neurosurg. 24, 743–748.PubMedCrossRefGoogle Scholar
  12. 12.
    Di Chiro, G., Ommaya, A. K., Ashburn, W. L., Briner, W. H., 1968: Isotope cisternography in the diagnosis and following of cerebrospinal fluid rhinorrhea. J. Neurosurg. 28, 522–529.PubMedCrossRefGoogle Scholar
  13. 13.
    Dietz, H., 1970: Die frontobasale Schädelhirnverletzung. Berlin-Heidelberg-New York: Springer.Google Scholar
  14. 14.
    Divitiis de, E., Spaziante, R., Stella, L., 1981: Empty sella and benign intrasellar cysts. In: Advances and Technical Standards in Neurosurgery, Vol. 8 (Krayenbühl, H., et al, eds.). Wien-New York: Springer.Google Scholar
  15. 15.
    Dohrmann, G. J., Patronas, N. J., Duda, E. E., Mullan, S., 1979: Cerebrospinal fluid rhinorrhea: Localization of dural fistulae using metrizamide, hypocycloidal tomography and computed tomography. Surg. Neurol. 11, 373–377.PubMedGoogle Scholar
  16. 16.
    Drayer, B. P., Wilkins, R. H., Boehnke, M., Horton, J. A., Rosenbaum, A. E., 1977: Cerebrospinal fluid rhinorrhea demonstrated by metrizamide CT cister-nography. A.J.R. 129, 149–151.Google Scholar
  17. 17.
    Drayer, B. P., Rosenheim, A. E., Higman, H. B., 1977: Cerebrospinal fluid imaging using serial metrizamide CT cisternography. Neuroradiology 13, 7–17.PubMedCrossRefGoogle Scholar
  18. 18.
    Drayer, B. P., Rosenbaum, A. E., 1978: Studies of the third circulation: Amipaque CT cisternography and ventriculography. J. Neurosurg. 48, 946–956.PubMedCrossRefGoogle Scholar
  19. 19.
    Einhorn, A., Mizrahi, E. M., 1978: Basilar skull fractures in children. The incidence of CNS infection and the use of antibiotics. Am. J. Dis. Child. 132, 1121–1124.PubMedGoogle Scholar
  20. 20.
    Gateholt, H., 1964: The reaction of glucose. Oxidase test paper in normal nasal secretion. Acta Otolaryngol. 58, 111–272.CrossRefGoogle Scholar
  21. 21.
    Greenblatt, S. H., Wilson, D. H., 1973: Persistent cerebrospinal fluid rhinorrhea treated by lumboperitoneal shunt. Technical note. J. Neurosurg. 38, 524–526.PubMedCrossRefGoogle Scholar
  22. 22.
    Guegan, Y., Adam, Y., Duplessis, Y., 1975: Une rhinorrhée spontanée d’étiologie rare. Neuro-Chirurgie (Paris) 21, 507–514.Google Scholar
  23. 23.
    Hooper, A. C, 1971: Sphenoidal defects—a possible cause of cerebrospinal fluid rhinorrhea. J. Neurol. Neurosurg. Psychiatry 34, 739–742.PubMedCrossRefGoogle Scholar
  24. 24.
    Ignelzi, R. J., Van der Ark, C. D., 1975: Analysis of the treatment of basilar skull fractures with and without antibiotics. J. Neurosurg. 43, 111–726.Google Scholar
  25. 25.
    Jakumeit, H.-D., 1971: Neuroblastoma of the olfactory nerve. Acta Neurochir. (Wien) 25, 99–108.CrossRefGoogle Scholar
  26. 26.
    Jefferson, A., Reilly, G., 1972: Fractures of the floor of the anterior cranial fossa. The selection of patients for dural repair. Br. J. Surg. 59, 585–592.PubMedCrossRefGoogle Scholar
  27. 27.
    Jordan, R., Kendal, J., Kerber, C, 1977: The primary empty sella syndrome. Am. J. Med. 62, 569–580.PubMedCrossRefGoogle Scholar
  28. 28.
    Klastersky, J., Sodeghi, M., Brihaye, N., 1976: Antimicrobial prophylaxis in patients with rhinorrhea or otorrhea: a double-blind study. Surg. Neurol. 6, 111–114.PubMedGoogle Scholar
  29. 29.
    Klastersky, J., Kahan-Coppens, L., Brihaye, J., 1979: Infection in neurosur-gery. In: Advances and Technical Standards in Neurosurgery, Vol.6 (Krayenbühl, H., et al, eds.). Wien-New York: Springer.Google Scholar
  30. 30.
    Landolt, A. M., Strebel, P., 1980: Technique of transsphenoidal operation for pituitary adenomas. In: Advances and Technical Standards in Neurosurgery, Vol.7 (Krayenbühl, H., et al, eds.). Wien-New York: Springer.Google Scholar
  31. 31.
    Laun, A., 1982: Traumatic cerebrospinal fluid fistulas in the anterior and middle cranial fossa. Acta Neurochir. (Wien) 60, 215–222.CrossRefGoogle Scholar
  32. 32.
    Lewin, W., Cairns, H., 1951: Fractures of the sphenoidal sinus with cerebrospinal rhinorrheas. Br. Med. J. 1, 1–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Lewin, W., 1954: Cerebro-spinal fluid rhinorrhea in closed head injuries. Brit. J. Surg. 42, 1–18.PubMedCrossRefGoogle Scholar
  34. 34.
    Little, J., Houser, O., MacGarty, C, 1975: Clinical manifestation of aqueductal stenosis in adults. J. Neurosurg. 43, 546–552.PubMedCrossRefGoogle Scholar
  35. 35.
    MacGee, E., Cauthen, J. C, Brackett, C. E., 1970: Meningitis following acute traumatic cerebro-spinal fluid fistula. J. Neurosurg. 33, 312–316.PubMedCrossRefGoogle Scholar
  36. 36.
    MacGee, E. E., 1976: Cerebro-spinal fluid fistula. In: Handbook Clinical Neurology, Vol.24, pp. 183–199. Amsterdam-Oxford: North-Holland Publ. Co.Google Scholar
  37. 37.
    Manelfe, C, Guirand, B., Tremulet, M., 1977: Diagnosis of CSF rhinorrhea by computerized cisternography using metrizamide. Lancet 2 (Letter), 1073.PubMedCrossRefGoogle Scholar
  38. 38.
    Manelfe, C, Guirand, B., Espagno, J., 1978: Cisternographie computérisée au metrizamide. Rev. Neurol. 134, 471–484.PubMedGoogle Scholar
  39. 39.
    Miller, C, 1826: Case of hydrocephalus chronicus, with some unusual symptoms and appearances on dissection. Trans, med-chir. Soc. Edinb. 2, 243.Google Scholar
  40. 40.
    Mincy, J. E., 1966: Posttraumatic cerebro-spinal fluid fistula of the frontal fossa. J. Trauma 6, 618–622.PubMedCrossRefGoogle Scholar
  41. 41.
    Naidich, T. P., Moran, C. J., 1980: Precise anatomic localization of a traumatic sphenoethmoidal cerebrospinal fluid rhinorrhea by metrizamide CT cisternography. J. Neurosurg. 53, 222–228.PubMedCrossRefGoogle Scholar
  42. 42.
    Nori, A., Carteri, A., 1964: Rinoliquorrea. Trattamento e resultati a distanza. Chir. Ital. 16, 161–164.PubMedGoogle Scholar
  43. 43.
    Oberson, R., 1976: La détection des fuites de liquide céphalorachidien par gammacisternographie. Neurochir. 22, 397–409.Google Scholar
  44. 44.
    Ommaya, A. K., 1976: Spinal fluid fistula. J. Neurosurg. 23, 363–392.Google Scholar
  45. 45.
    Pertuiset, B., Metzger, J., 1973: Les rhinorrhées paradoxales par dislocations axiales traumatiques de l’étage antérieur. Neurochir. 20, 21–24.Google Scholar
  46. 46.
    Pertuiset, B., 1974: Supratentorial craniotomy. In: Advances and Technical Standards in Neurosurgery, Vol. 1 (Krayenbühl, H., et al, eds.). Wien-New York: Springer.Google Scholar
  47. 47.
    Price, D. J. E., Sleigh, J. D., 1970: Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet 4, 1213–1215.CrossRefGoogle Scholar
  48. 48.
    Raaf, J., 1967: Post-traumatic cerebro-spinal fluid leaks. Arch. Surg. 95, 648–651.PubMedGoogle Scholar
  49. 49.
    Ray, B. S., Bergland, R. M., 1969: Cerebrospinal fluid fistula: Clinical aspects, techniques of localization, and methods of closure. J. Neurosurg. 30, 399–405.PubMedCrossRefGoogle Scholar
  50. 50.
    Robert, A., 1847: Mémoire sur la nature de l’écoulement aqueux très abondant qui accompagne certaines fractures du crane. Mem. Sor. Chir. 1, 563–615.Google Scholar
  51. 51.
    Rousseaux, P., Scherpereel, B., 1981: Fractures de l’étage antérieur. Notre attitude thérapeutique ä propos de 1254 cas sur une série de 11 200 traumatismes craniens. Neurochir. 27, 15–19.Google Scholar
  52. 52.
    Rovit, R., Schechter, M., Nelson, K., 1969: Spontaneous high pressure cerebrospinal rhinorrhea due to lesions obstructing flow of cerebrospinal fluid. J. Neurosurg. 30, 406–412.PubMedCrossRefGoogle Scholar
  53. 53.
    Sawicka, I. H., Trosser, A., 1983: Cerebro-spinal fluid. Rhinorrhea after cocain sniffing. Brit. Med. J. (Clin. Res.) 283, 1476–1477.CrossRefGoogle Scholar
  54. 54.
    Spetzler, R. F., Wilson, C. B., 1978: Management of recurrent CSF rhinorrhea of the middle and posterior fossa. J. Neurosurg. 49, 393–397.PubMedCrossRefGoogle Scholar
  55. 55.
    Tillaux, P. J., 1877: Traité d’anatomie topographique avec applications à la chirurgie. Paris.Google Scholar
  56. 56.
    Tönnis, W., 1948: Sollen die Verletzungen der vorderen Schädelbasis operativ versorgt werden? Chirurg 19, 13–15.PubMedGoogle Scholar
  57. 57.
    Tönnis, W., 1948: Die Chirurgie des Gehirns und seiner Häute. In: Die Chirurgie, Bd. III, 2. Aufl. (Kirschner-Nordmann, Hrsg.), pp. 453–880. Wien: Urban und Schwarzenberg.Google Scholar
  58. 58.
    Vigouroux, R. P., 1971: Rhinorrhées spontanées d’origine tumorale. Neurochir. 19, 245–294.Google Scholar
  59. 59.
    Visot, A., Cophignon, J., Derome, P., 1979: Rhinorrhée cérébrospinale. A propos de 140 observations. Ann. Chir. (Paris) 33, 319–327.Google Scholar

Copyright information

© Springer-Verlag/Wien 1984

Authors and Affiliations

  • F. Loew
    • 1
  • B. Pertuiset
    • 2
  • E. E. Chaumier
    • 2
  • H. Jaksche
    • 1
  1. 1.Neurochirurgische KlinikUniversität des SaarlandesHomburg/SaarFederal Republic of Germany
  2. 2.Clinique Neuro-Chirurgicale UniversitaireHôpital de la PitiéParisFrance

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