Scientific Online Resource System

International Bulletin of Otorhinolaryngology

A diagnostic approach for identifying defects in the rhinobase

K. Dzhambazov, A. Topalova


Introduction: Rhinoliquorrhea is a condition characterized by a cerebrospinal fluid leak through the nasal cavity due to a bone or
dural defect in the rhinobase. It can be associated with serious lifethreatening conditions such as ascending bacterial infections from
the non-sterile nasal cavity to the subarachnoid space – meningitis,
meningoencephalitis, brain abscess, and others. The diagnostic approach for identifying rhinoliquorrhea is multidisciplinary and depends on the knowledge of different specialists – otolaryngologists, neurosurgeons, general practitioners, radiologists.
Materials and methods: For the 2015 – 2019 period 23 patients were
diagnosed with rhinoliquorrhea at the Department of Otorhinolaryngology,
University Hospital St. George, Plovdiv. They were verified by glucose and Beta-2 transferrin tests. We performed computed tomography, magnetic resonance imaging and cisternography. In cases of a negative CT finding for defects in the rhinobase but clinically positive, we used the method of applying fluorescein intrathecally with intraoperative positivity at the site of the defect.
Results: We confirmed pre-operatively that all patients have rhinoliquorrhea, though the localization of the defect in 3 of them differed
intraoperatively. In one of the clinical cases, the topical diagnosis of
rhinoliquorrhea was not possible despite the positive result of Beta-2
transferrin. Intraoperatively, we detected many small defects in the
rhinobase area and, in some cases, meningocele in the area of the
olfactory rhyme. For most patients the hospital stay lasted for 7 days,
while one patient had an intracranial complication – a brain abscess.
In all patients we used an endonasal endoscopic approach to surgically
treat the defects in the rhinobase.
Conclusion: The diagnostic approach for identifying defects in the
rhinobase requires knowledge of the symptom “rhinoliquorrhea”,
confirmation of its presence by biochemical tests, and detection
the osteodural defect by imaging. The diagnostic difficulties arise
from the diversity in the etiology, the topic and the medical history
of the patient. A long-undetected rhinoliquorrhea may have fatal
consequences for the patient, thus making it a socially significant


rhinoliquorrhea, CSF leak, rhinobase, skull base, beta-2 transferrin, osteodural defect

Full Text


Schlosser RJ, Bolger WE. Management of multiple spontaneous nasal meningoencephaloceles. Laryngoscope. 2002 Jun;112(6): 980–985.

Woodworth BA, Prince A, Chiu AG, et al. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg. 2008 Jun; 138(6): 715–720. doi: 10.1016/j.otohns.2008.02.010.

Kaufman B, Nulsen FE, Weiss MH, Brodkey JS, White RJ, Sykora GF. Acquired spontaneous, nontraumatic normal-pressure cerebrospinal fluid fistulas originating from the middle fossa. Radiology. 1977 Feb; 122(2): 379–387

Lee TJ, Huang CC, Chuang CC, Huang SF. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience. Laryngoscope. 2004 Aug; 114(8): 1475–1481.

Dzhambazov K., Markov S, Topalova A. CSF Fluid rhinorrhea-diagnostic methods review and clinical cases demonstration. International bulletin of Oto Rhino Laryngology 2015.

Wise SK, Schlosser RJ. Evaluation of spontaneous nasal cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg. 2007 Feb; 15(1): 28–34.

Psaltis AJ, Schlosser RJ, Banks CA, Yawn J, Soler ZM. Asystematic review of the endoscopic repair of cerebrospinalfluid leaks. Otolaryngol Head Neck Surg. 2012 Aug; 147(2): 196–203. doi: 10.1177/0194599812451090.

McMains KC, Gross CW, Kountakis SE. Endoscopic management of cerebrospinal fluid rhinorrhea. Laryngoscope. 2004 Oct; 114(10): 1833–1837.

Purkey MT, Woodworth BA, Hahn S, Palmer JN, Chiu AG. Endoscopic repair of supraorbital ethmoid cerebrospinal fluid leaks. ORL J Otorhinolaryngol Relat Spec. 2009; 71(2): 93 98. doi:10.1159/000193219.

Meco C, Oberascher G, Arrer E, et al. Beta-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula. Otolaryngol Head Neck Surg. 2003; 129(5): 508–517

Shetty PG, Shroff MM, Fatterpekar GM, Sahani DV, Kirtane MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol. 2000; 21: 337–342.



Font Size