Endoscopic-Assisted Fluorescein-Guided Repair of CSF Rhinorrhea in a Case of Spontaneous CSF Leak

Abstract Cerebrospinal fluid (CSF) leaks in the form of rhinorrheas and otorrheas are known entities in case of traumatic brain injuries. However, spontaneous CSF leaks are rare in incidence. It happens due to a bony defect at the skull base with an associated breach in the dura and arachnoid layer along with a sinonasal disruption. We, at this moment, present the case of a 44-year-old woman with a spontaneous onset CSF rhinorrhea for 1 month. She was evaluated with imaging CT cisternography. However, as the defect was small, it was difficult to identify the site of CSF rhinorrhea. Therefore, intrathecal fluorescein dye was administered, and the dye could be visualized with the naked eye under endoscopic white light as a green color after 20 to 30 minutes. The location was identified and was plugged with a Hadad flap and fat plug. The location of the CSF leak needs to be identified with modalities like CT or MR cisternography, but it becomes challenging if the leak site is small. Hence, the use of intraoperative modalities to determine the location of a leak needs to be done meticulously for a successful outcome.