The Necessity of Surgical Repair in Recurrent Spontaneous CSF Rhinorrhoea After Failed Conservative Management: A Prospective Clinical Study.

Spontaneous cerebrospinal fluid (CSF) rhinorrhoea, often linked to benign intracranial hypertension (BIH), arises from skull base defects and carries a risk of serious complications such as meningitis. While acetazolamide can temporarily reduce intracranial pressure, recurrence remains problematic. This prospective study aims to assess the relationships between body mass index (BMI), defect size, disc edema severity, and recurrence duration, and to compare outcomes of conservative versus surgical management. A prospective observational study was conducted on 30 adults with spontaneous CSF rhinorrhoea from November 2021 to October 2023. Initial treatment involved oral acetazolamide (250 mg thrice daily); patients with recurrence underwent endoscopic endonasal repair. All surgical patients received two doses of the pneumococcal vaccine, 8 weeks apart. Associations between BMI, defect size, disc edema, and recurrence duration were analysed using Pearson's correlation coefficient. Mean BMI was 26.63, and mean defect size was 7.37 mm. Moderate positive correlations were observed between BMI and recurrence duration (r = 0.45,  = 0.018), and between disc edema and recurrence duration (r = 0.52,  = 0.004). A weak yet significant correlation was found between defect size and recurrence duration (r = 0.38,  = 0.032). Conservative management failed in all cases; recurrence occurred in 100% of patients, necessitating surgical repair, which achieved a high success rate with minimal postoperative recurrence. Acetazolamide offers temporary relief but fails to prevent recurrence. Early surgical intervention is recommended in spontaneous CSF rhinorrhoea to ensure better long-term outcomes and reduce the risk of complications, particularly in patients with elevated BMI or advanced papilledema.