A breach in the bony barrier between the sinus cavity and the anterior or middle cranial fosse can lead to a leakage of the Cerebro-spinal fluid which accumulates in the sinus cavity. The presence of the para-nasal sinuses anatomically is such that they lie very close to the base of the skull and many types of problems can lead to accumulation of the fluid in the sinus cavity. This could lead to a variety of other problems for the patient which may even include infection among others. The main reason for the presence of CSF fluid in the sinus cavity is due to a rupture in the Arachnoid and Duramater (which are coverings of the brain) along with a fracture in the base of the skull. This leads to a pressure gradient being established in the direction of the fracture. In an adult there are various types of CSF Rhinorrhea which are classified and mentioned below-
- Non-surgical cases- there usually result due to penetrating injuries and form a major part of all the cases of CSF leakage into the sinus cavity. Most of these cases are reported following vehicle accidents.
- Surgical cases- sometimes during or after surgeries involving the cranial cavity patients can report problems associated with CSF leakage.
- CSF leakage associated with Tumors- few conditions such as inverted papilloma or malignancies can result in leakage of the CSF fluid into the sinus cavity and this problem is corrected at the time of surgery.
- Spontaneous or idiopathic causes- these cases are reported without a history of trauma usually and the only cause associated with them is an increase in the intra-cranial pressure.
Such patients usually report with problems such as nasal discharge or severe headaches. There may be associate issues of blurred vision. The fluid accumulated in the sinus cavity keeps draining with change in position of the patient and this is known as the reservoir sign. The patient should undergo a proper clinical examination which must include a proper check-up of the nasal cavity and the cranial region. In patients suffering from head injuries blood may complicate matters and in these cases a proper diagnosis becomes difficult to establish. Most commonly meningitis is found to be associated with the presence of fluid in sinus cavity.
There are a few diagnostic tests that are required to be performed in cases of presence of fluid in sinus cavity to help in confirming the diagnosis:-
- MRI of the cranial or head region
- MRI of the spine
- CT scan of the head region
- Radioisotope Cisternography
- Injecting Fluorescein into the Cerebrospinal fluid.
The mode of treatment followed in this case is a surgical repair if there is a fracture caused due to a traumatic injury. In case of a non-surgical patient generally a less aggressive approach is followed. The patient is advised around a week of bed rest, prescribed antibiotics and laxatives and a mode of drainage is established to remove the fluid from the sinus cavity. However, if this fails to work then, surgery is the only option left to correct the problem. So, now that you know the complications that may arise due to the presence of fluid in the sinus cavity you would have realized that it is a pretty serious matter. In case there is any such problem that arises at your home then you should immediately rush the patient to a specialist so that treatment-surgical or nonsurgical is started at the earliest. A proper diagnosis can go a long way in providing long-term relief from the problem and all possible diagnostic aids that can help must be considered.