A unique case report of bilateral spontaneous cerebrospinal fluid leak from bilateral sphenoid sinus skull base defects

Abstract

This brief report describes the presentation and management of a rare case of bilateral spontaneous cerebrospinal fluid (CSF) leaks resulting from skull base dehiscence in the sphenoid sinus lateral recess. A retrospective review of clinical data, including imaging and surgical interventions, was conducted. Informed consent was obtained. A middle-aged, obese woman presented with clear rhinorrhoea. Imaging identified bilateral encephaloceles and skull base defects. She underwent successful endoscopic surgery with fat grafts and septal flap repair, with no CSF leak recurrence at follow-ups.
Contribution: To our knowledge, this case is one of the few documented examples of bilateral spontaneous CSF leaks from skull base dehiscence in the sphenoid sinus. Endoscopic sinus surgery provides a minimally invasive, effective repair. Anatomical variations, such as extensive sphenoid sinus pneumatisation and congenital defects, combined with factors such as high body mass index, may predispose patients to spontaneous CSF leaks.