Cerebrospinal fluid fistula

Cerebrospinal fluid is a transparent liquid in which the brain and spinal cord is bathed.

Cerebrospinal fluid fistulas consist of a loss of said liquid through the nose. It is due to a pathological communication between the intracranial space and the nasal cavity caused by a lesion in the meninge and the bone structure at the base of the cranium.

Its origins can be congenital or spontaneous, or due to traumatism or surgery (secondary effects of surgery at the base of the cranium or endoscopic nasal surgery).

It manifests itself clinically by a loss of liquid from the nose similar in appearance to water and in most cases with a predominance on one side. It occurs especially with changes in posture or physical exertion.

Diagnosis is achieved using imaging techniques or by finding beta 2 transferrin in the unusual discharge.

It is a very dangerous situation because in many cases these fistulas can cause meningitis or bacterial contamination in the nasal cavity. Therefore, it is essential that they are repaired.

The approach chosen to surgically close the CSF fistulas is based on size and location, and the presence or absence of brain herniation in the nasal cavity. If brain herniation is present then an open approach via a craneotomy is chosen. If the dimensions of the fistula allow it, the closure can be performed by endoscopic surgery through the nose and sealing the fistula with fascia lata (aponeurotic muscle tissue) and with spare skin or blood vessels from the turbinates; fat obtained with the fascia lata can also be used.