Vestibular schwannomas are benign tumors of the cerebellopontine angle commonly managed by microsurgical excision. Cerebrospinal fluid (CSF) leak is a known post-operative complication; however, delayed CSF rhinorrhea through the ipsilateral nostril is a rare presentation. We report a case of a 45-year-old male who underwent right retrosigmoid suboccipital craniotomy and tumor excision for vestibular schwannoma. The post-operative period was initially uneventful, but the patient later presented with intermittent headache, pseudomeningocele formation, and clear nasal discharge on forward bending. Imaging revealed a post-operative pseudomeningocele with CSF tracking into the mastoid air cells. Surgical exploration confirmed dural rent with communication to mastoid air cells and the Eustachian tube pathway leading to rhinorrhea. Dural repair with muscle patch graft and obliteration of mastoid air cells using bone wax resulted in complete resolution of CSF leak. This case highlights the importance of early recognition and surgical management of delayed CSF rhinorrhea following posterior fossa surgery.
Mal et al. (Mon,) studied this question.