Image guided repair of spontaneous CSF rhinorrhoea secondary to double skull base defect – Case report and review of literature

Abstract Introduction The presence of concomitant skull base defects resulting in spontaneous CSF rhinorrhea is an extremely rare entity with only 7 such cases reported to date. All of these cases whether done endoscopically/transcranially initially needed transmastoid or transcranial repair later apart from one report where both defects were repair simultaneously. We report the first case repaired simultaneously via a single craniotomy. Identification of such defects pre-operatively and intra-operatively are very important to prevent recurrence and associated morbidities. Case report We present a case report of a 38-year-old patient with a double skull base defect who presented with spontaneous CSF rhinorrhea. Since the two defects were not in the same coronal plane and thus difficult to approach simultaneously via endoscopy hence a transcranial approach using neuro-navigation to repair both defects was undertaken. Also, a complete review of literature of all cases of double skull base defects showed that simultaneous access of both defects is essential to prevent re-surgery and hence a single craniotomy was used to repair both these defects. Conclusion Any case presenting with spontaneous CSF rhinorrhea should undergo repair immediately after a thorough investigation of the site of the leak. This is a benign condition which if treated early can lead to a very satisfying resolution of symptoms. Preoperative identification of all defects can prevent re-surgery and simultaneous repair should be the goal at all times.