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Diagnosis, Evaluation and Management of CSF Rhinorrhea

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Rhinology and Facial Plastic Surgery

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Abstract

■ The etiologies of CSF fistulae include accidental trauma, iatrogenic causes, tumors, encephaloceles, and spontaneous leaks.

■ A thorough head and neck evaluation including nasal endoscopy must be performed if suspicious for a CSF leak. If able to collect rhinorrhea, the fluid should be sent for a beta-2-transferrin assay.

■ Select the appropriate imaging modality when working-up a leak. High-resolution CT demonstrates the bony skull base and its defects. If suspicious for encephalocele, MRI (magnetic resonance imaging) should be performed.

■ Consider the etiology of the leak when deciding the treatment. Conservative measures such as bed rest, stool softeners, and head of bed elevation may resolve a traumatic leak. Acetazolamide (Diamox) and lumbar drain placement are other alternatives which may negate the need for surgical repair.

■ Endoscopic repair of CSF fistulae has become the method of choice in most clinical scenarios.

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Author information

Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, UNC-CH School of Medicine, 1115 Bioinformatics Bldg. CB# 7070, 27599-7070, Chapel Hill, NC, USA

    Jeffrey B. LaCour

  2. Department of Otolaryngology – Head and Neck Surgery, University of North Carolina School of Medicine, 27599-7070, Chapel Hill, NC, USA

    Brent A. Senior

Authors
  1. Jeffrey B. LaCour
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  2. Brent A. Senior
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Editor information

Editors and Affiliations

  1. Department of Otolaryngology, Louisiana State University, Health Science Center, 1501 Kings Highway, 71130, Shreveport, LA, USA

    Fred J. Stucker Prof.  & Timothy S. Lian Dr.  & 

  2. State University of New York, Brooklyn, USA

    Chris de Souza Dr.

  3. Health Sciences Center, Louisiana State University, Shreveport, USA

    Chris de Souza Dr.

  4. The Tata Memorial Hospital, Lilavati Hospital, Holy Family Hospital, Mumbai, India

    Chris de Souza Dr.

  5. Department of Otolaryngology, Whipps Cross Hospital, Whipps Cross Road, E11 1NR, Leytonstone, UK

    Guy S. Kenyon Dr.

  6. Department of Ear, Nose and Throat Diseases, Head and Neck Surgery, International Neuroscience Institute at the University of Magdeburg (INI), Rudolf-Pichlmayr-Str. 4, 30625, Hannover, Germany

    Wolfgang Draf Prof. Dr.

  7. Department of Otolaryngology, University Homburg/Saar, Kirrberger Straße, 66421, Homburg/Saar, Germany

    Bernhard Schick Dr.

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© 2009 Springer-Verlag Berlin Heidelberg

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LaCour, J., Senior, B. (2009). Diagnosis, Evaluation and Management of CSF Rhinorrhea. In: Stucker, F., de Souza, C., Kenyon, G., Lian, T., Draf, W., Schick, B. (eds) Rhinology and Facial Plastic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-74380-4_42

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  • DOI: https://doi.org/10.1007/978-3-540-74380-4_42

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-74379-8

  • Online ISBN: 978-3-540-74380-4

  • eBook Packages: MedicineMedicine (R0)

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