Bibi Hasnain M.D.              St. Luke’s Medical Center
Ventricular atrial shunt, a novel and effective treatment of spontaneous CSF rhinorrhea   
         
 

We present the first case report of a patient with intrasellar cisternal herniation and empty sella, who was successfully treated with ventricular atrial shunt for spontaneous and persistent CSF Rhinorrhea. One of the etiologies which has been hypothesized for intrasellar cisternal herniation is intermittent increase in the CSF pressure. Our patient presented with spontaneous CSF Rhinorrhea from a defect in the left cribriform plate. In addition the patient also had defects in the right cribriform plate and in the floor of the sella turcica. It was concluded that intrasellar cisternal herniation, the defects within the roof of paranasal sinuses and the spontaneous CSF leak was secondary to a rare complication of communicating hydrocephalus. It was decided that the best treatment of the CSF leak, halting further bony remodeling, preventing pituitary damage and resolving the pathophysiologic process was placement of a ventricular atrial shunt. The CSF leak resolved once the ventricular atrial shunt was placed and the valve pressure was adjusted.

Our case report not only reinforces increased intracranial pressure as an etiology of subarachnoid cisternal herniation but also furnishes a method for effective treatment of this unique condition.