Author(s)
Shireen A. Samargandy, MBBS, FRCSC
Christian G. Fritz, BS
Vidur Bhalla, MD
John M. Lee, MD, FRCSC
Christopher H. Le, MD
Affiliation(s)
Department of Otolaryngology–Head and Neck Surgery, University of Arizona, Tucson, AZ, USA
Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
Abstract:
Background: Nasopharyngeal swab tests are an essential tool for COVID-19 screening. Iatrogenic cerebrospinal fluid (CSF) leak resulting from anterior skull base trauma is a rare and incompletely understood complication of nasopharyngeal swab testing.
Methods: Retrospective institutional case-series of traumatic anterior skull base CSF leak with clear antecedent history of COVID-19 swab was completed. A comprehensive search of EMBASE, MEDLINE, Scopus was performed for the systematic literature review and meta-analysis.
Results: Thirty-three patients with traumatic CSF leak after COVID-19 nasopharyngeal swab testing were identified. Women were more than twice as likely to experience a CSF leak, as compared to men (22 vs 10 cases). The majority of patients (64.7%) had no reported predisposing factor in their clinical history. Common defect sites included the cribriform plate (52%), sphenoid sinus (32%), and ethmoid roof (16%). Four patients (12%) presented with Meningitis. The median time between the traumatic COVID swab and the detection of CSF leak was 4 weeks (IQR 1-8). Patients with meningitis had a median Leak Duration of 12 weeks (IQR 8-18). The average leak duration was significantly longer in patients with meningitis compared to without meningitis (p=.02), with a moderate effect size (r=-0.4). Most cases (79%) were successfully managed with endoscopic endonasal surgical repair.
Conclusions: This report clarifies the presentation, risk factors, and management of CSF leaks attributable to diagnostic nasopharynx swabbing procedures in the COVID-19 era. Timely surgical repair is the recommended management option for such leaks.