CSF Rhinorrhea: The Case for Conservative Treatment with the Use of Acetazolamide

Introduction: Defects in the floor of the anterior cranial fossa can lead to leakage of CSF into the nasal cavity. Trauma, both surgical and other (head injury), causes 90% of all cases of CSF rhinorrhea. Given the increased performance of procedures of the endoscopic sinus, the number of patients with CSF rhinorrhea has increased.

Material and Method: A 43-year-old female patient was presented for consultation. She had a history of a unilateral watery discharge, anosmia, and headache relieved by changes in head position. An endoscopic ethmoidectomy and sphenoidectomy had been offered to her 1 month previously. CT scan revealed a bony defect (fistula) in the region of the cribriform plate and air cells of the ethmoid sinus. Conservative management was used, consisting of bed rest in a head-up position and avoidance of coughing, sneezing, nose-blowing, and heavy lifting. Acetazolamide was used as an adjunct therapy for decreasing CSF production.

Results: The leakage stopped spontaneously within 1 month.

Conclusion: CSF rhinorrhea can occur as a result of iatrogenic surgical trauma. In the case of early-onset traumatic fistula, a conservative approach can be used. Other causes require a more aggressive intervention, such as endoscopic and external techniques.