Nontraumatic Cerebrospinal Fluid Rhinorrhea

Abstract

A PATIENT with rhinorrhea presents an interesting problem in diagnosis and appropriate treatment. Ommaya et al 1 have recently offered a new classification of the disease, which they designate as cerebrospinal fluid (CSF) rhinorrhea. They subdivide it into high pressure and low pressure types and further classify it as indicated in Fig 1. Because of the possibility of repeated attacks of meningitis after apparent spontaneous closure of a fistula, 2 they advocate aggressive surgical attack on the disease. Di Chiro et al 3 have recently described the use of isotope cisternography to diagnose, and indeed, locate the site of a CSF leak, the prerequisite of surgical management. Two cases of nontraumatic CSF rhinorrhea were recently seen at the National Hospital in which a fistula arose at a site unusual for this disease, apparently as a result of a persistent craniopharyngeal canal. Also, in both cases, the rhinorrhea stopped