FRCS (ORL-HNS) · SECTION 1 SBA

Postoperative CSF rhinorrhoea

On day 3 after extended endoscopic skull-base surgery, a patient develops a constant clear unilateral nasal discharge that increases on leaning forward. There is no meningism. What is the best next principle?

CHOOSE ONE ANSWER

Best of five

  1. A. Reassure and use saline irrigation
  2. B. Urgent skull-base-team assessment to confirm and manage a suspected CSF leak
  3. C. Blind nasal cautery
  4. D. Start antihistamines and review in a month
  5. E. Perform lumbar puncture before involving the surgical team
ANSWER AND REASONING

B. Urgent skull-base-team assessment to confirm and manage a suspected CSF leak

A postoperative CSF leak risks meningitis and repair failure. Confirmation and management require a planned skull-base pathway rather than treating it as routine rhinitis.

Why every option is right or wrong

A. Reassure and use saline irrigation: This may delay recognition of a dural breach.

B. Urgent skull-base-team assessment to confirm and manage a suspected CSF leak: A postoperative CSF leak risks meningitis and repair failure. Confirmation and management require a planned skull-base pathway rather than treating it as routine rhinitis.

C. Blind nasal cautery: This neither diagnoses nor repairs a leak.

D. Start antihistamines and review in a month: The temporal relation and positional clear drainage require urgent assessment.

E. Perform lumbar puncture before involving the surgical team: Investigation and diversion decisions must be coordinated with the skull-base team.

What if the scenario changed?

If beta-2 transferrin testing and imaging excluded a leak, non-CSF postoperative rhinorrhoea could be managed conservatively.