Spontaneous Cerebrospinal Fluid Rhinorrhea: Correlation with Body Weight and Radiological Data

Objectives: Search for correlations between spontaneous cerebrospinal fluid rhinorrhea (SCSFR) and overweight/obesity and imaging data. Methods: Retrospective study of SCSFR cases operated (1993-2013) in a tertiary center. A two-sided test was used for statistics. Results: There were 17 patients operated for SCSFR: 9 females/8 males; mean age 45 years (range 3-84). Abnormalities on CT were: bone defect (12), sinus opacity (11). Abnormalities on MRI: continuity with meninges (7), meningocele (6), empty sella (6), dilation of optic nerve sheath (6), and pneumocephalus (1). Patients underwent endoscopic closure of osteomeningeal defect with fat. Primary success rate was 13/17 (76.5%). Regarding body mass index (BMI), 12 patients/17 (70.6%) were overweight (BMI > 25) versus 32% in the French general population (p = 0.001). Among patients with SCSFR and overweight, 3/12 (25%) were obese (BMI > 30) versus 15% in overweight individuals (p = 0.483). Increased pneumatization of sinuses was observed in 15/17 (88%) versus 35% in general population (p = 0.00009). Empty sella was found in 6/17 (35.3%) versus 5.5% in general population (p = 0.0002). Dilation of optic nerve sheath was observed in 6/17 (35.3%) versus 10% in general population (p = 0.0047). Conclusion: We found statistically significant correlations between SCSFR and overweight, increased pneumatization of sinuses, empty sella, and dilation of optic nerve sheath, but not with obesity. This could be due to the small number of patients & a weak statistical power for obesity. The two-sided test is ideal for small samples of patients but a greater number is needed in the future to confirm these preliminary results.