Dural venous sinus stenting as a stand-alone treatment for spontaneous skull base CSF leak secondary to venous pseudotumor cerebri syndrome

Most spontaneous CSF leaks (SCSFL) are associated with an underlying pseudotumor cerebri syndrome (PTCS). Treatment generally includes surgical leak repair and PTCS correction, as untreated PTCS carries a risk of recurrence. We describe a 72-year-old woman with rhinorrhea, aural fullness, and posterior nasal drip. CT and MRI showed signs of CSF hypovolemia and PTCS, as well as bilateral transverse sinus stenoses. CT and MRI cisternography documented CSF leaks through the right cribriform plate and the posterior aspect of the petrous bone. Opening CSF pressure was 6 cm H2O. Dural venous sinus stenting (DVSS) was performed after failed conservative treatment. Rhinorrhea resolved 3 days after stenting, aural fullness 1 month later. After 6 months, signs of CSF hypovolemia had disappeared on MRI and the stents were patent. After 9 months, the patient had a transient, spontaneously resolving episode of rhinorrhea. She has been symptom-free for the remaining 39 months of follow-up.