Abstract
Introduction Cerebrospinal fluid (CSF) leaks through the nasal cavity occurrence has a rising
trend, of which primary spontaneous leak is 6 to 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, and 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 four female patients; four patients had high body mass index. The most common
site of leak was mid-clivus and surgical technique employed was multilayer dural plasty
with a nasoseptal flap and measures were taken to reduce the intracranial pressure
intra-operatively and postoperatively.
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.
Keywords
spontaneous clival leaks - clivus - spontaneous CSF rhinorrhea - IIH
