International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea
International Forum of Allergy & Rhinology, vol. 11, pp. 794–803
Abstract
BACKGROUND: The association between spontaneous cerebrospinal fluid (CSF) leak/rhinorrhea and idiopathic intracranial hypertension (IIH) has been increasingly recognized over the last years. However, considerable variability of opinion regarding the assessment, investigations, and management of patients with spontaneous CSF rhinorrhea remains. METHODS: A consensus group was formed from experts from Europe, Asia, Australia, South and North America. Following literature review and open discussions with members of the panel, a set of 61 statements was produced. A modified Delphi method was used to refine expert opinion with 3 rounds of questionnaires and a consensus group meeting in Santo-Rhino meeting in September 2019. RESULTS: Fifty statements (82% of total) on spontaneous CSF leak and IIH reached consensus. In 38 of 50 statements, the median response was 7 (strongly agree) and in the 12 remaining statements the median response was 6 (agree). Eleven statements were excluded because they did not reach consensus and one new statement was added during SantoRhino meeting. The final statements refer to patient history and clinical examination ("History taking should include presence of headache, tinnitus and visual defects"), investigations (role of Thin Slice Computed Tomography and CISS/FLAIR sequences in Magnetic Resonance Imaging), principles of management (watchful waiting or measures to reduce ICP are supplementary but cannot subsitute surgical closure), surgical technique, intraoperative, early postoperative and long term management. CONCLUSION: We present fifty consensus statements on the diagnosis, investigation, and management of spontaneous CSF rhinorrhea based on the currently available evidence and expert opinion. Although by no means comprehensive and final, we believe they can contribute to the standardization of clinical practice. Early diagnosis, prompt surgical closure of the defect, assesment for and treatment of potentially co-existing idiopathic intracranial hypertension in a comprehensive multidisciplinary approach are essential in order to successfully manage spontaneous CSF rhinorrhea, reduce associated morbidity and prevent recurrence.
Authors 18
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Christos Georgalas corresponding
University of Nicosia · Hygeia Hospital
Affiliation as printed
Endoscopic Skull Base Centre Athens Hygeia Hospital Erythrou Stavrou 4 Maroussi Athens, 15123 Greece
Medical School University of Nicosia 93 Agiou Nikolaou Street, Engomi Nicosia 2408 Cyprus
Endoscopic Skull Base Centre Athens, Hygeia Hospital, Erythrou Stavrou 4, Maroussi, Athens, 15123 Greece
Medical School, University of Nicosia, 93 Agiou Nikolaou Street, Engomi, Nicosia, 2408 Cyprus
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Affiliation as printed
Department of Neurosurgery Evangelismos University Hospital Athens Athens Greece
Department of Neurosurgery, Evangelismos University Hospital Athens, Athens, Greece
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Affiliation as printed
Department of ENT and Skull Base Surgery Birmingham Hospital Birmingham UK
Department of ENT and Skull Base Surgery, Birmingham Hospital, Birmingham, UK
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Affiliation as printed
Department of Otorhinolaryngology University of Insubria Varese Italy
Department of Otorhinolaryngology, University of Insubria, Varese, Italy
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Azienda Ospedaliera Universitaria Pisana
Affiliation as printed
Department of Otolaryngology ‐ Head and Neck Surgery Azienda Ospedaliero‐Universitaria Pisana Pisa Italy
Department of Otolaryngology - Head and Neck Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Wouter van Furth Aachen Department of Neurosurgery Leiden University Medical Center (LUMC) Leiden Netherlands Department of Neurosurgery, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Neurosurgery Leiden University Medical Center (LUMC) Leiden Netherlands
Department of Neurosurgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
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Affiliation as printed
Sydney ENT clinic Sydney Australia
Sydney ENT clinic, Sydney, Australia
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Affiliation as printed
Department of Otolaryngology Hôpital Lariboisière Paris France
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Affiliation as printed
Department of Neurosurgery Hygeia Hospital Athens Greece
Department of Neurosurgery, Hygeia Hospital, Athens, Greece
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Affiliation as printed
Neurosurgical Clinic, Insubria University, ASST Settelaghi Varese Italy
Neurosurgical Clinic, Insubria University, ASST Settelaghi, Varese, Italy
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Ankara University · Paracelsus Medical University
Affiliation as printed
Department of ORL‐HNS Ankara University Medical School Ankara Turkey
Department of ORL‐HNS Salzburg Paracelsus Medical University Salzburg Austria
Department of ORL-HNS, Ankara University Medical School, Ankara, Turkey
Department of ORL-HNS, Salzburg Paracelsus Medical University, Salzburg, Austria
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Hospital of the University of Pennsylvania
Affiliation as printed
Otorhinolaryngology–Head and Neck Surgery Hospital of the University of Pennsylvania Philadelphia PA
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Universidade Federal do Rio Grande do Sul · Hospital de Clínicas de Porto Alegre
Affiliation as printed
ENT Department Hospital de Clinicas de Porto Alegre ‐ UFRGS Brazil
ENT Department, Hospital de Clinicas de Porto Alegre - UFRGS, Brazil
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Affiliation as printed
ENT Surgeon Spire Nottingham Hospital Nottingham UK
ENT Surgeon, Spire Nottingham Hospital, Nottingham, UK
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Charing Cross Hospital · Imperial College London
Affiliation as printed
Department of Otolaryngology ‐ Head and Neck Surgery Charing Cross Hospital London UK
ENT Surgery Imperial College London UK
Department of Otolaryngology - Head and Neck Surgery, Charing Cross Hospital, London, UK
ENT Surgery, Imperial College, London, UK
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Affiliation as printed
ENT Cleveland Clinic Cleveland OH
ENT Cleveland Clinic, Cleveland, OH
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Affiliation as printed
Department of Otorhinolaryngology UZ Ghent University Hospital Gent Belgium
Department of Otorhinolaryngology, UZ Ghent University Hospital, Gent, Belgium
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University of Alabama at Birmingham · UAB Medicine
Affiliation as printed
Department of Otolaryngology University of Alabama at Birmingham Birmingham AL
Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL
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