Single Operation to Repair Multifocal Cerebrospinal Fluid Fistulae Following Gunshot Wound: A Case Report

Abstract Introduction Traumatic cerebrospinal fluid (CSF) fistulae can be a challenging neurosurgical disease, often requiring complicated surgical intervention. Case Presentation A 54-year-old man presented with a gunshot wound to the head with complex injury to the skull base and significant CSF leakage from multiple sites. A single surgery was performed using a combined Neurosurgery, Neurotology, and Rhinology team, which was successful in repairing the multiple skull base defects and preventing further CSF leak. Discussion Trauma to the skull base is a common inciting factor for the development of CSF fistulae. Endoscopic approaches are often preferred for repairing these defects, but craniotomy remains a viable option that may be required in more complex cases. A combined approach has not been described previously, but was successful for this severe multifocal defect. Conclusion A multidisciplinary approach allowed for a combined intervention that addressed both the anterior and middle fossae fistulae simultaneously. This limited the potential infectious complications of continued CSF leak and allowed for early rehabilitation.

[1]  Journal of Neurological Surgery Reports , 2018 .

[2]  P. Recinos,et al.  The utility of lumbar drains in modern endoscopic skull base surgery , 2015, Current opinion in otolaryngology & head and neck surgery.

[3]  A. Langerman,et al.  Bilateral middle cranial fossa encephaloceles presenting as conductive hearing loss. , 2013, Ear, nose, & throat journal.

[4]  C. Banks,et al.  A Systematic Review of the Endoscopic Repair of Cerebrospinal Fluid Leaks , 2012, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[5]  N. Margalit,et al.  Multidisciplinary surgical approach for cerebrospinal fluid leak in children with complex head trauma , 2009, Child's Nervous System.

[6]  A. R. Gezici,et al.  An Effective and Less Invasive Treatment of Post-Traumatic Cerebrospinal Fluid Fistula: Closed Lumbar Drainage System , 2008, Minimally invasive neurosurgery : MIN.

[7]  Pierre Robe,et al.  Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience. , 2008, Neurosurgery.

[8]  D. Locatelli,et al.  Endoscopic Endonasal Approaches for Repair of Cerebrospinal Fluid Leaks: Nine-Year Experience , 2006, Neurosurgery.

[9]  R. Delfini,et al.  Severe craniofacial fractures with frontobasal involvement and cerebrospinal fluid fistula: indications for surgical repair. , 2005, Surgical neurology.

[10]  S. Dogan,et al.  Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases , 2005, Neurosurgical Review.

[11]  G. Oberascher,et al.  Comprehensive Algorithm for Skull Base Dural Lesion and Cerebrospinal Fluid Fistula Diagnosis , 2004, The Laryngoscope.

[12]  Wei Liao,et al.  [Traumatic nasal cerebrospinal fluid fistula: report of 86 cases]. , 2003, Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA.

[13]  M. Taylor,et al.  Management of Cerebrospinal Fluid Leaks Involving the Temporal Bone: Report on 92 Patients , 2003, The Laryngoscope.

[14]  P. Jabbour,et al.  [Subcranial subfrontal approach for the treatment of extensive cerebrospinal fluid leaks]. , 2002, Neuro-Chirurgie.

[15]  I. Mosnier,et al.  Brain herniation and chronic otitis media: diagnosis and surgical management. , 2000, Clinical otolaryngology and allied sciences.

[16]  C. Snyderman,et al.  Endoscopic Repair of Cerebrospinal Fluid Leaks to the Sinonasal Tract: Predictors of Success , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[17]  J. Piek.  Surgical treatment of complex traumatic frontobasal lesions: personal experience in 74 patients. , 2000, Neurosurgical focus.

[18]  Gady Har‐el,et al.  What is “Spontaneous” Cerebrospinal Fluid Rhinorrhea? Classification of Cerebrospinal Fluid Leaks , 1999, The Annals of otology, rhinology, and laryngology.

[19]  M. Wigand.  [Enlarged middle fossa approach to the cerebello-pontine angle. Technique and indications]. , 1998, Revue de laryngologie - otologie - rhinologie.

[20]  T. C. Thompson,et al.  Management of complications from 820 temporal bone fractures. , 1997, The American journal of otology.

[21]  G. Harsh,et al.  Bilateral temporal bone encephaloceles after cranial irradiation. Case report. , 1993, Journal of neurosurgery.

[22]  A. Cerejo,et al.  The galea frontalis myofascial flap in anterior fossa CSF leaks. , 1993, British journal of plastic surgery.

[23]  G. Moore,et al.  Extracranial Approaches to the Repair of Cerebrospinal Fluid Rhinorrhea , 1992, Ear, nose, & throat journal.

[24]  L. Marentette,et al.  Traumatic anterior fossa cerebrospinal fluid fistulae and craniofacial considerations. , 1991, Otolaryngologic clinics of North America.

[25]  John Kuhn,et al.  Diagnosis and treatment of iatrogenic cerebrospinal fluid leak and brain herniation during or following mastoidectomy , 1985, The Laryngoscope.

[26]  B. Pertuiset,et al.  Traumatic, spontaneous and postoperative CSF rhinorrhea. , 1984, Advances and technical standards in neurosurgery.

[27]  V. Strelzow,et al.  Current Management of Cerebrospinal Fluid Rhinorrhea , 1983, The Laryngoscope.

[28]  M. Glasscock,et al.  Surgical management of brain tissue herniation into the middle ear and mastoid , 1979, The Laryngoscope.

[29]  W. Lewin.  Cerebrospinal fluid rhinorrhea in nonmissile head injuries. , 1964, Clinical neurosurgery.