Primary Spontaneous Cerebrospinal Fluid Rhinorrhoea.

The adjective 'spontaneous' as applied to cerebrospinal fluid rhinorrhoea simply indicates that the discharge is not an immediate or delayed result of trauma. Cases of spontaneous cerebrospinal fluid rhinorrhoea can be subdivided into two distinct groups, secondary and primary. In the secondary group an obvious cause for the leak is present. This -may be some gross lesion producing erosion of the skull base; examples of such lesions are osteomata of the nasal sinuses, intracranial neoplasms, particularly pituitary adenoma and craniopharyngioma, and internal hydrocephalus due to neoplastic or other cause; the lesion may be a meningocele or or meningo-encephalocele, the rhinorrhoea at times following attempts to treat the swelling by an intranasal operation. In the primary group no cause for the leak of cerebrospinal fluid can be found, and it is with this group ofunknown aetiology that the present communication is concerned. As is the case in all medical problems, so in that of cerebrospinal fluid rhinorrhoea adequate knowledge of the relevant anatomy and physiology is essential if abnormalities are to be recognized and understood. In the second century Galen had observed the fluid in the ventricles of the brain and considered it a waste product to be excreted via the pituitary into the nose. Vesalius and the other great anatomists of the middle ages also mentioned the fluid and in the seventeenth and eighteenth centuries Willis and Cotugno studied it. Probably it was the publication of the results of his researches, carried out over a period of 15 years, by Magendie in 1842 that contributed most to a general understanding of the anatomy and physiology of the cerebrospinal fluid. The post-traumatic discharge of fluid from the nose had been described by Bidloo the elder (quoted by St Clair Thomson, 1899) in the seventeenth century. The first description of what was certainly spontaneous cerebrospinal fluid rhinorrhoea was given by Miller in 1826. He gives the history of a boy with a progressively enlarging head who developed a recurring discharge of fluid from his nose and in whom a large internal hydrocephalus was revealed at necropsy;