Chronic hydrocephalus and suprasellar arachnoid cyst presenting with rhinorrhea

Spontaneous CSF leak with rhinorrhea may be secondary to many intracranial congenital and acquired conditions. However, no cases of chronic hydrocepha lus and suprasellar arachnoid cyst presenting with rhinorrhea as the unique clinical manifestation are reported in the literature. A 29-year-old-man w ith four-month history of episodic rhinorrhea had a large suprasellar arach noid cyst with chronic hydrocephalus on magnetic resonance. Endoscopic vent ricular fenestration of the cyst failed to obtain remission of the CSF leak , because it was not possible to fenestrate the cyst with the almost comple tely obliterated suprasellar cistern. Clinical remission occurred after res toration of the CSF flow from the cyst to the cisternal spaces by a direct approach. The CSF leak in this case was secondary to the chronic compressio n over the dural and bone structures of the sellar region by the cyst or ch ronic hydrocephalus.