Etiology and evidence-based management of CSF rhinorrhea: Clinical outcomes in the endoscopic era

Background: Cerebrospinal fluid (CSF) rhinorrhea is the leakage of CSF into the nasal cavity due to a skull base defect and carries risks such as meningitis and intracranial complications. Early diagnosis and appropriate intervention are essential to prevent morbidity and mortality. Aims and Objective: This study aims to assess the demographic profile, etiology, anatomical leak sites, diagnostic findings, and treatment outcomes in patients with CSF rhinorrhea. Materials and Methods: A hospital-based descriptive observational study was conducted on 33 consecutively enrolled patients diagnosed with CSF rhinorrhea at a tertiary care center in Tamil Nadu between August 2022 and March 2024. All eligible patients presenting to the otorhinolaryngology outpatient department or emergency services during the study period were included using a consecutive sampling method; patients not meeting inclusion criteria or declining consent were excluded. Diagnosis was confirmed using biochemical and radiological assessment. Data on etiology, clinical features, imaging findings, anatomical site and size of leak, management, and outcomes were collected. Conservative management was initially attempted, and patients with persistent leaks underwent endoscopic surgical repair. Outcomes were assessed in terms of leak resolution, post-operative complications, and recurrence. Data were analyzed using descriptive statistics. Results: Of the 33 patients enrolled, most were male (24; 72.7%) and aged 31–40 years (11; 33.3%). Trauma was the most common etiology (21; 63.6%), followed by spontaneous leaks (12; 36.4%). The cribriform plate was the most common site in spontaneous cases (7; 58.3%), whereas the frontal sinus was more frequent in traumatic cases (6; 28.6%). Leak size was 3–5 mm in the majority of spontaneous (7; 58.3%) and traumatic cases (11; 52.4%). Conservative treatment was successful in most traumatic cases (19; 90.5%), while all spontaneous leaks required surgical repair (12; 100%), with no post-operative recurrence. Conclusion: Traumatic CSF rhinorrhea was more common and often resolved with conservative treatment, whereas spontaneous leaks required surgical repair and demonstrated favorable short-term outcomes.