CASE REPORT
As fístulas liquóricas primárias espontâneas, originadas de lesões ósseas no clivus, são excepcionalmente raras. Neste artigo relatamos o caso de uma paciente de 60 anos que apresentava rinorreia unilateral direita. A investigação revelou uma lesão óssea de 3 mm na porção superior do clivus e drenagem de líquor para o interior do seio esfenoidal. A paciente foi submetida a cirurgia endoscópica endonasal transesfenoidal. Durante o procedimento, a fístula foi identificada e ocluída com uma combinação de cola biológica, enxerto de gordura abdominal e retalho nasosseptal vascularizado. Após três anos de acompanhamento, a paciente permanece assintomática e sem sinais de recorrência da rinorreia.
Spontaneous primary cerebrospinal fluid (CSF) fistulas originating from bony lesions in the clivus are exceptionally rare. We describe the case of a 60-year-old female patient who presented with unilateral right-sided rhinorrhea. The investigation revealed a 3 mm bony lesion in the upper portion of the clivus and CSF drainage into the sphenoid sinus. The patient underwent an endoscopic endonasal transsphenoidal surgery. During the procedure, the fistula was identified and occluded with a combination of biological glue, abdominal fat graft, and a vascularized nasoseptal flap. After three years of follow-up, the patient remains asymptomatic and shows no signs of rhinorrhea recurrence.
1. Van Zele T, Kitice A, Vellutini E, Balsalobre L, Stamm A. Primary spontaneous cerebrospinal fluid leaks located at the clivus. Allergy Rhinol. 2013;4(2):e100-4. https://doi.org/10.2500/ar.2013.4.0053. PMid:24124635.
2. Backaert W, De Vleeeschouwer S, Van Gerven L. Spontaneous and idiopathic CSF leak in the infrasellar clival region. B-ENT. 2018;14:295-8.
3. Chawla P, Misra BK. A rare case report of primary spontaneous transclival CSF rhinorrhea. Neurol India. 2025;73(2):393-5. https:// doi.org/10.4103/NI.NI_673_20. PMid:40176243.
4. Hayashi Y, Iwato M, Kita D, Fukui I. Spontaneous cerebrospinal fluid leakage through fistulas at the clivus repaired with endoscopic endonasal approach. Surg Neurol Int. 2015;6(1):106. https://doi.org/10.4103/21527806.158898. PMid:26110086.
5. Oles K, Składzien J, Betlej M, Chrzan R, Mika J. Spontaneous cerebrospinal fluid leak at the clivus. Wideochir Inne Tech Malo Inwazyjne. 2015;10(4):593-9. https://doi.org/10.5114/wiitm.2015.55676. PMid:26865899.
6. Prather K, Shi HH, McKinney KA, Dunn IF. Chronic cerebrospinal fluid rhinorrhea as an initial presentation of chordoma: illustrative case. J Neurosurg Case Lessons. 2023;5(14):case2347. https://doi.org/10.3171/ CASE2347. PMid:37014007.
7. Martin C, Leclercq D, Boch AL, Jublanc C, Kuhn E. Determinants of cerebrospinal fluid leakage in a large cohort of macroprolactinomas. Ann Endocrinol. 2025;86(2):101685. https://doi.org/10.1016/j.ando.2025.101685. PMid:39818291.
8. Banks CA, Palmer JN, Chiu AG, O’Malley BW Jr, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg. 2009;140(6):826-33. https:// doi.org/10.1016/j.otohns.2008.12.060. PMid:19467398.
9. Takabayashi K, Iwama J, Takizawa K. Spontaneous cerebrospinal fluid leakage at the clivus: minimally invasive surgery without external autograft harvesting. Cureus. 2023;15(10):e48009. https:// doi.org/10.7759/cureus.48009. PMid:38034190.
10. Mohindra S, Mohindra S, Joshi K, Sodhi HS. Delayed spontaneous cerebrospinal leak through clival recess: emphasis on technique of repair. Clin Rhinol An Int J. 2017;10(1):42-4. https://doi.org/10.5005/ jp-journals-10013-1304.
11. Ogasawara CT, Young K, Bonilla PJ, Noh T, Cho J. Primary spontaneous inferior clival cerebrospinal fluid leak. Cureus. 2021;13(9):e17967. https:// doi.org/10.7759/cureus.17967. PMid:34660152.
12. Sara KB, Upreti G, Thomas H, et al. Spontaneous clival leaks and their management. J Neurol Surg B Skull Base. 2025;86(2):165-72. https://doi.org/10.1055/a-2300-4130. PMid:40104535.
13. Aroca AC, Cabrerizo JRG, Delago MDJ, Solench HM. Spontaneous cerebrospinal fluid fistula in the clivus. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134(6):431-4. https://doi.org/10.1016/j.anorl.2016.10.007. PMid:28410953.
14. Airomaih SA. Pathophysiology of skull base defects and cerebrospinal fluid leak. Saudi J Otorhinolaryngol Head Neck Surg. 2021;23(3):91-4. https://doi.org/10.4103/sjoh.sjoh_52_20.
1Division of Neurosurgery, Complexo Hospitalar Unimed, Novo Hamburgo, RS, Brasil.
2Division of Otorhinolaryngology, Complexo Hospitalar Unimed, Novo Hamburgo, RS, Brasil.
3Division of Radiology, Complexo Hospitalar Unimed, Novo Hamburgo, RS, Brasil.
Received Sep 14, 2025
Corrected Jan 20, 2025
Accepted Feb 10, 2026
