Spontaneous cerebrospinal fluid rhinorrhea associated with empty sella: a transnasal-transsphenoidal repair of the fistula.

Spontaneous cerebrospinal rhinorrhea is a rare clinical condition. More commonly it develops due to cerebral tumors or hydrocephalus; it is seldom seen in association with empty sella syndrome. A sixty-three-year-old woman who presented with left nasal discharge was hospitalized on the suspicion of CSF rhinorrhea. Analysis of the nasal fluid revealed a clear color, a positive Pandy's test, and a positive result for glucose (72%). On magnetic resonance scans, herniation of the suprasellar cistern was observed into the sellar cavity, and the left sphenoid sinus was filled with contrast medium. The repair of the fistula was performed via a transnasal and transsphenoidal approach. The patient was followed-up for five years without any symptoms or recurrences.