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J Neurol Surg Rep 2016; 77(02): e89-e93
DOI: 10.1055/s-0036-1584281
Case Report
Georg Thieme Verlag KG Stuttgart · New York

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

Gabrielle A. White-Dzuro
1   Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, United States
,
Pouya Entezami
2   Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
,
George Wanna
3   Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, United States
,
Paul Russell
3   Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, United States
,
Lola B. Chambless
1   Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, United States
› Author Affiliations
Further Information

Publication History

31 December 2015

18 April 2016

Publication Date:
09 June 2016 (online)

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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.

Keywords

cerebrospinal fluid fistulae - CSF leak - endoscopic endonasal approach - skull base repair
 

  • References

  • 1 Plein CT, Langerman AJ, Redleaf MI. Bilateral middle cranial fossa encephaloceles presenting as conductive hearing loss. Ear Nose Throat J 2013; 92 (12) E14-E16
    PubMedGoogle Scholar
  • 2 Yilmazlar S, Arslan E, Kocaeli H , et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev 2006; 29 (1) 64-71
    CrossrefPubMedGoogle Scholar
  • 3 Dalgic A, Okay HO, Gezici AR, Daglioglu E, Akdag R, Ergungor MF. An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: closed lumbar drainage system. Minim Invasive Neurosurg 2008; 51 (3) 154-157
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Liao W, Lin SH, Huang HT. Traumatic nasal cerebrospinal fluid fistula: report of 86 cases [in Chinese]. J First Mil Med Univ 2003; 23 (6) 629-630
    PubMedGoogle Scholar
  • 5 Park JI, Strelzow VV, Friedman WH. Current management of cerebrospinal fluid rhinorrhea. Laryngoscope 1983; 93 (10) 1294-1300
    CrossrefPubMedGoogle Scholar
  • 6 Scholsem M, Scholtes F, Collignon F , et al. Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience. Neurosurgery 2008; 62 (2) 463-469 , discussion 469–471
    CrossrefPubMedGoogle Scholar
  • 7 Daly DT, Lydiatt WM, Ogren FP, Moore GF. Extracranial approaches to the repair of cerebrospinal fluid rhinorrhea. Ear Nose Throat J 1992; 71 (7) 311-313
    PubMedGoogle Scholar
  • 8 Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery 2006; 58 (4) (Suppl. 02) ONS-246-ONS-256 , ONS-256–ONS-257
    PubMedGoogle Scholar
  • 9 Loew F, Pertuiset B, Chaumier EE, Jaksche H. Traumatic, spontaneous and postoperative CSF rhinorrhea. Adv Tech Stand Neurosurg 1984; 11: 169-207
    PubMedGoogle Scholar
  • 10 Rocchi G, Caroli E, Belli E, Salvati M, Cimatti M, Delfini R. Severe craniofacial fractures with frontobasal involvement and cerebrospinal fluid fistula: indications for surgical repair. Surg Neurol 2005; 63 (6) 559-563 , discussion 563–564
    CrossrefPubMedGoogle Scholar
  • 11 Zweig JL, Carrau RL, Celin SE , et al. Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: predictors of success. Otolaryngol Head Neck Surg 2000; 123 (3) 195-201
    CrossrefPubMedGoogle Scholar
  • 12 Nohra G, Jabbour P, Haddad A, Abouhamad W, Abilahoud G, Okais N. Subcranial subfrontal approach for the treatment of extensive cerebrospinal fluid leaks [in French]. Neurochirurgie 2002; 48 (2–3, Pt 1): 87-91
    PubMedGoogle Scholar
  • 13 Har-El G. What is “spontaneous” cerebrospinal fluid rhinorrhea? Classification of cerebrospinal fluid leaks. Ann Otol Rhinol Laryngol 1999; 108 (4) 323-326
    CrossrefPubMedGoogle Scholar
  • 14 Psaltis AJ, Schlosser RJ, Banks CA, Yawn J, Soler ZM. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2012; 147 (2) 196-203
    CrossrefPubMedGoogle Scholar
  • 15 Lewin W. Cerebrospinal fluid rhinorrhea in nonmissile head injuries. Clin Neurosurg 1964; 12: 237-252
    PubMedGoogle Scholar
  • 16 Marentette LJ, Valentino J. Traumatic anterior fossa cerebrospinal fluid fistulae and craniofacial considerations. Otolaryngol Clin North Am 1991; 24 (1) 151-163
    PubMedGoogle Scholar
  • 17 Meco C, Oberascher G. Comprehensive algorithm for skull base dural lesion and cerebrospinal fluid fistula diagnosis. Laryngoscope 2004; 114 (6) 991-999
    CrossrefPubMedGoogle Scholar
  • 18 Piek J. Surgical treatment of complex traumatic frontobasal lesions: personal experience in 74 patients. Neurosurg Focus 2000; 9 (1) e2
    PubMedGoogle Scholar
  • 19 Costa H, Cerejo A, Baptista A , et al. The galea frontalis myofascial flap in anterior fossa CSF leaks. Br J Plast Surg 1993; 46 (6) 503-507
    CrossrefPubMedGoogle Scholar
  • 20 Savva A, Taylor MJ, Beatty CW. Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients. Laryngoscope 2003; 113 (1) 50-56
    CrossrefPubMedGoogle Scholar
  • 21 Wigand ME. Enlarged middle fossa approach to the cerebello-pontine angle. Technique and indications [in French]. Rev Laryngol Otol Rhinol (Bord) 1998; 119 (3) 159-162
    PubMedGoogle Scholar
  • 22 Fishman G, Fliss DM, Benjamin S , et al. Multidisciplinary surgical approach for cerebrospinal fluid leak in children with complex head trauma. Childs Nerv Syst 2009; 25 (8) 915-923
    CrossrefPubMedGoogle Scholar
  • 23 Stokken J, Recinos PF, Woodard T, Sindwani R. The utility of lumbar drains in modern endoscopic skull base surgery. Curr Opin Otolaryngol Head Neck Surg 2015; 23 (1) 78-82
    PubMedGoogle Scholar
  • 24 Glasscock III ME, Dickins JR, Jackson CG, Wiet RJ, Feenstra L. Surgical management of brain tissue herniation into the middle ear and mastoid. Laryngoscope 1979; 89 (11) 1743-1754
    PubMedGoogle Scholar
  • 25 Lalwani AK, Jackler RK, Harsh IV GR, Butt FY. Bilateral temporal bone encephaloceles after cranial irradiation. Case report. J Neurosurg 1993; 79 (4) 596-599
    CrossrefPubMedGoogle Scholar
  • 26 Mosnier I, Fiky LE, Shahidi A, Sterkers O. Brain herniation and chronic otitis media: diagnosis and surgical management. Clin Otolaryngol Allied Sci 2000; 25 (5) 385-391
    CrossrefPubMedGoogle Scholar
  • 27 Neely JG, Kuhn JR. Diagnosis and treatment of iatrogenic cerebrospinal fluid leak and brain herniation during or following mastoidectomy. Laryngoscope 1985; 95 (11) 1299-1300
    PubMedGoogle Scholar
  • 28 Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures. Am J Otol 1997; 18 (2) 188-197
    Google Scholar