{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T04:22:35Z","timestamp":1742962955005,"version":"3.40.3"},"reference-count":49,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Cerebrospinal fluid (CSF) leaks through the nasal cavity occurrence has a rising trend, of which primary spontaneous leak is 6 to 40% of all the CSF leaks. The most common site of CSF leak is ethmoid roof where the bone is thinner in the entire skull base. Clivus being the hard bone is a rare site for spontaneous leak. We present a case series from a single quaternary care center of this rare occurrence and study its reason and management strategy.<\/jats:p><jats:p>\n          Materials and Methods\u2003A retrospective surgical audit over a period of 10 years of all patients diagnosed with CSF rhinorrhea was done. A PubMed search was conducted with keywords of CSF leak, CSF rhinorrhea, spontaneous CSF rhinorrhea, clival leak, and clivus to identify the literature and these articles were compiled and their management reviewed.<\/jats:p><jats:p>\n          Results and Analysis\u2003A total of 100 patients underwent surgical management for spontaneous CSF leak, of which there were 5 patients who had spontaneous CSF rhinorrhea from the clivus. There were four female patients; four patients had high body mass index. The most common site of leak was mid-clivus and surgical technique employed was multilayer dural plasty with a nasoseptal flap and measures were taken to reduce the intracranial pressure intra-operatively and postoperatively.<\/jats:p><jats:p>\n          Conclusion\u2003Spontaneous clival leak is a rare entity with mid and lower clivus being the common site. A combined approach by ENT and neurosurgeons results in best outcome for the patients.<\/jats:p>","DOI":"10.1055\/a-2300-4130","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T23:54:50Z","timestamp":1712361290000},"page":"165-172","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous Clival Leaks and Their Management"],"prefix":"10.1055","volume":"86","author":[{"given":"Katti Blessi","family":"Sara","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1519-9553","authenticated-orcid":false,"given":"Garima","family":"Upreti","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, All India Institute of Medical Sciences Rajkot, Rajkot, Gujarat, Rajkot, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habie","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Philip","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajan","family":"Sundaresan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edmond Jonathan","family":"Gandham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2069-1799","authenticated-orcid":false,"given":"Regi","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1177\/019459989110400402","article-title":"Primary spontaneous cerebrospinal fluid rhinorrhea","volume":"104","author":"R N Beckhardt","year":"1991","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/MOO.0b013e328011bc76","article-title":"Evaluation of spontaneous nasal cerebrospinal fluid leaks","volume":"15","author":"S K Wise","year":"2007","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1136\/jnnp.31.3.214","article-title":"Non_traumatic cerebrospinal fluid rhinorrhoea","volume":"31","author":"A K Ommaya","year":"1968","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1288\/00005537-198101000-00017","article-title":"Non-traumatic cerebrospinal fluid rhinorrhea","volume":"91","author":"J MA Shugar","year":"1981","journal-title":"Laryngoscope"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1055\/s-0038-1676334","article-title":"Management of spontaneous CSF rhinorrhea: an institutional experience","volume":"80","author":"A Keshri","year":"2019","journal-title":"J Neurol Surg B Skull Base"},{"issue":"09","key":"ref6","doi-asserted-by":"crossref","first-page":"e831","DOI":"10.1097\/MAO.0000000000001969","article-title":"The bone mineral density of the lateral skull base and its relation to obesity and spontaneous CSF leaks","volume":"39","author":"J L Hatch","year":"2018","journal-title":"Otol Neurotol"},{"issue":"02","key":"ref7","first-page":"337","article-title":"A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings","volume":"21","author":"P G Shetty","year":"2000","journal-title":"AJNR Am J Neuroradiol"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1136\/jnnp.34.6.739","article-title":"Sphenoidal defects\u2013a possible cause of cerebrospinal fluid rhinorrhoea","volume":"34","author":"A C Hooper","year":"1971","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1080\/02688697.2017.1346173","article-title":"Canalis basalis medianus with cerebrospinal fluid leak: rare presentation and literature review","volume":"33","author":"S Khairy","year":"2019","journal-title":"Br J Neurosurg"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1007\/s00330-006-0208-3","article-title":"Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study","volume":"16","author":"R G Haetinger","year":"2006","journal-title":"Eur Radiol"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/SCS.0b013e3181c5a294","article-title":"Extended endoscopic endonasal approach to the clival region","volume":"21","author":"B Abuzayed","year":"2010","journal-title":"J Craniofac Surg"},{"issue":"07","key":"ref12","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/s00701-007-1183-4","article-title":"Transclival cerebrospinal fluid fistula in a patient with Marfan's syndrome","volume":"149","author":"A Ramos","year":"2007","journal-title":"Acta Neurochir (Wien)"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1167\/iovs.11-8220","article-title":"Body mass index has a linear relationship with cerebrospinal fluid pressure","volume":"53","author":"J P Berdahl","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/j.otohns.2008.12.060","article-title":"Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years","volume":"140","author":"C A Banks","year":"2009","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1227\/00006123-199510000-00030","article-title":"Spontaneous cerebrospinal fluid fistula through the clivus: report of two cases","volume":"37","author":"D Coiteiro","year":"1995","journal-title":"Neurosurgery"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.otohns.2010.07.011","article-title":"The utility of intrathecal fluorescein in cerebrospinal fluid leak repair","volume":"143","author":"R Seth","year":"2010","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref17","first-page":"161","article-title":"Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery","volume":"61","author":"D G Placantonakis","year":"2007","journal-title":"Neurosurgery"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1002\/lary.23277","article-title":"Is the use of topical fluorescein helpful for management of CSF leakage?","volume":"122","author":"K Ozturk","year":"2012","journal-title":"Laryngoscope"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1097\/01.mlg.0000217532.77298.a8","article-title":"Topical intranasal fluorescein: the missing partner in algorithms of cerebrospinal fluid fistula detection","volume":"116","author":"M E Saafan","year":"2006","journal-title":"Laryngoscope"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/WNO.0000000000000303","article-title":"Brain imaging in idiopathic intracranial hypertension","volume":"35","author":"S Bidot","year":"2015","journal-title":"J Neuroophthalmol"},{"issue":"11","key":"ref21","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1002\/lary.21151","article-title":"Spontaneous CSF leaks: factors predictive of additional interventions","volume":"120","author":"R Seth","year":"2010","journal-title":"Laryngoscope"},{"issue":"07","key":"ref22","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.crad.2011.12.002","article-title":"Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension","volume":"67","author":"P J Maralani","year":"2012","journal-title":"Clin Radiol"},{"issue":"13","key":"ref23","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1212\/WNL.0b013e3182a55f17","article-title":"Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children","volume":"81","author":"D I Friedman","year":"2013","journal-title":"Neurology"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"532","DOI":"10.4103\/0028-3886.144453","article-title":"Endoscopic management of CSF rhinorrhea","volume":"62","author":"R R Sannareddy","year":"2014","journal-title":"Neurol India"},{"issue":"09","key":"ref25","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1002\/lary.26612","article-title":"Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks","volume":"127","author":"W Teachey","year":"2017","journal-title":"Laryngoscope"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"763","DOI":"10.2214\/ajr.135.4.763","article-title":"Extracranial complications of cerebrospinal fluid shunt function in childhood hydrocephalus","volume":"135","author":"F R Murtagh","year":"1980","journal-title":"AJR Am J Roentgenol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/000348948008900202","article-title":"Extracranial surgical repair of cerebrospinal rhinorrhea","volume":"89","author":"T C Calcaterra","year":"1980","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"02","key":"ref28","first-page":"188","article-title":"Lumboperitoneal shunts: review of 409 cases","volume":"52","author":"Y R Yadav","year":"2004","journal-title":"Neurol India"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3171\/jns.1978.48.1.0146","article-title":"Migration of ventriculoperitoneal shunt into the chest. Case report","volume":"48","author":"J R Cooper","year":"1978","journal-title":"J Neurosurg"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.pediatrneurol.2005.05.020","article-title":"Failure of cerebrospinal fluid shunts: part I: obstruction and mechanical failure","volume":"34","author":"S R Browd","year":"2006","journal-title":"Pediatr Neurol"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jcms.2012.11.011","article-title":"Anatomical restrictions in the transsphenoidal, transclival approach to the upper clival region: a cadaveric, anatomic study","volume":"41","author":"U Aktas","year":"2013","journal-title":"J Craniomaxillofac Surg"},{"key":"ref32","first-page":"1","article-title":"European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base","volume":"22","author":"V J Lund","year":"2010","journal-title":"Rhinol Suppl"},{"issue":"01","key":"ref33","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3171\/jns.1979.50.1.0031","article-title":"Neurovascular relationships of the sphenoid sinus. A microsurgical study","volume":"50","author":"K Fujii","year":"1979","journal-title":"J Neurosurg"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"553","DOI":"10.3171\/jns.1980.53.4.0553","article-title":"CSF rhinorrhea from a transclival meningocele demonstrated with metrizamide CT cisternography. Case report","volume":"53","author":"A H Lockwood","year":"1980","journal-title":"J Neurosurg"},{"issue":"05","key":"ref35","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/BF01411183","article-title":"CSF rhinorrhea from a transclival meningocele demonstrated by MR","volume":"138","author":"F S Turanzas","year":"1996","journal-title":"Acta Neurochir (Wien)"},{"issue":"03","key":"ref36","first-page":"232","article-title":"Spontaneous cerebrospinal fluid rhinorrhea through clival defect","volume":"10","author":"A A Al-Shurbaji","year":"2005","journal-title":"Neurosciences (Riyadh)"},{"issue":"11","key":"ref37","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1016\/j.jocn.2006.10.012","article-title":"Primary spontaneous CSF rhinorrhea through the clivus: possible etiopathology","volume":"15","author":"F U Ahmad","year":"2008","journal-title":"J Clin Neurosci"},{"issue":"02","key":"ref38","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1552-6569.2007.00187.x","article-title":"CSF rhinorrhea from a transclival meningocele: a case report","volume":"18","author":"M Akyuz","year":"2008","journal-title":"J Neuroimaging"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1001\/archoto.2008.550","article-title":"Endoscopic management of idiopathic spontaneous skull base fistula through the clivus","volume":"135","author":"H A Elrahman","year":"2009","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"02","key":"ref40","doi-asserted-by":"crossref","first-page":"e100","DOI":"10.2500\/ar.2013.4.0053","article-title":"Primary spontaneous cerebrospinal fluid leaks located at the clivus","volume":"4","author":"T Van Zele","year":"2013","journal-title":"Allergy Rhinol (Providence)"},{"issue":"02","key":"ref41","doi-asserted-by":"publisher","first-page":"328","DOI":"10.4103\/1793-5482.144202","article-title":"Clival defect causing primary spontaneous rhinorrhea","volume":"12","author":"V Tandon","year":"2017","journal-title":"Asian J Neurosurg"},{"issue":"06","key":"ref42","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.neucir.2015.02.008","article-title":"Rinorraquia secundaria a meningocele transclival. A prop\u00f3sito de un caso y revisi\u00f3n de la literatura","volume":"26","author":"R Zanabria-Ortiz","year":"2015","journal-title":"Neurocirugia (Astur)"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4103\/2152-7806.158898","article-title":"Spontaneous cerebrospinal fluid leakage through fistulas at the clivus repaired with endoscopic endonasal approach","volume":"6","author":"Y Hayashi","year":"2015","journal-title":"Surg Neurol Int"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.wneu.2015.11.026","article-title":"Endoscopic Management of Spontaneous Clival Cerebrospinal Fluid Leaks: Case Series and Literature Review","volume":"86","author":"F Pagella","year":"2016","journal-title":"World Neurosurg"},{"issue":"06","key":"ref45","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.anorl.2016.10.007","article-title":"Spontaneous cerebrospinal fluid fistula in the clivus","volume":"134","author":"A Codina Aroca","year":"2017","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1052.e1","DOI":"10.1016\/j.wneu.2017.07.011","article-title":"Clival Defect with Primary CSF Rhinorrhea: A Very Rare Presentation with Challenging Management","volume":"106","author":"S Asad","year":"2017","journal-title":"World Neurosurg"},{"issue":"06","key":"ref47","doi-asserted-by":"crossref","first-page":"e604","DOI":"10.1097\/SCS.0000000000004690","article-title":"Endoscopic management of spontaneous cerebrospinal fluid fisstula caused by clival defect","volume":"29","author":"R Karli","year":"2018","journal-title":"J Craniofac Surg"},{"issue":"05","key":"ref48","doi-asserted-by":"crossref","first-page":"e9758","DOI":"10.1097\/MD.0000000000009758","article-title":"Spontaneous cerebrospinal fluid rhinorrhea: A case report and analysis","volume":"97","author":"G Y Chen","year":"2018","journal-title":"Medicine (Baltimore)"},{"issue":"05","key":"ref49","doi-asserted-by":"crossref","first-page":"E24","DOI":"10.1177\/0145561319839507","article-title":"A Primary Clival Defect: Endoscopic Binostril Approach With Nasal Septal Flap Closure and Preservation of Septal Integrity","volume":"98","author":"J F Nogueira","year":"2019","journal-title":"Ear Nose Throat J"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2300-4130.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T22:32:39Z","timestamp":1742941959000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2300-4130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,5]]},"references-count":49,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2025,3,17]]},"published-print":{"date-parts":[[2025,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2300-4130","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"type":"print","value":"2193-6331"},{"type":"electronic","value":"2193-634X"}],"subject":[],"published-other":{"date-parts":[[2024,4,5]]},"published":{"date-parts":[[2024,4,5]]}}}