Spontaneous CSF Leaks Caused by Double Skull Base Defects: Case Report

Problems: This is a case report of a double spontaneous cerebrospinal leak. A 49-years-old female came to our attention for an intermittent clear rhinorrhea, with no other associated symptoms and a history of previous surgery for an anterior skull base leak. Methodology: The rhinorrhea was considered at first as a consequence of the previous surgical repair, but the intraoperative fluorescein test showed another unexpected site of leak in the floor of the middle cranial fossa of the temporal bone. Results: The bone defect was thus surgically repaired with success through a transmastoid approach. Conclusions: This case-report offers matter of discussion about the possibility of double spontaneous cerebrospinal leak in the skull base, which should be always investigated with preoperative imaging both in the anterior and lateral skull base as to avoid erroneous diagnosis of site. The surgical options to repair anterior and lateral skull base defects are discussed as well.