Abstract

Spontaneous cerebrospinal fluid(CSF) fistula constitutes only 3% to 4% of all CSF fistulas. The posterior wall of sphenoid sinus is rarely implicated as a site of spontaneous CSF fistula. A 41-year-old woman was admitted for headache, fever and continuous rhinorrhea. She had not experienced head injury. The CT scan revealed the pneumocephalus and a defect at the posterior part of sphenoid sinus. Bacterial meningitis was diagnosed by the CSF examination. The rhinorrhea was found to have a glucose content compatible with CSF. By isovist CT cisternography, we found? CSF fistula was likely to be on the left posterior wall of sphenoid sinus. We performed transnasal endoscopic sinus surgery with anti- biotic treatment. She recovered from her symptoms and has been free of CSF rhinorrhea. Because CSF rhinorrhea and pneumocephalus implicates the bony defect, rapid evaluation and treatment for a CSF leak site is essential.