Traumatic cerebrospinal fluid (CSF) leakage is reported to occur in 1%–3% cases of severe head injury. New onset cases could be improved by conservative management, while surgical treatment is recommended for late-onset and recurrent cases. Herein, we report a case of recurrent CSF leakage that developed 22 years after head injury, which was successfully closed by an intracranial and transsphenoidal approach. A 57-year-old-man had been diagnosed as having traumatic CSF leakage 22 years earlier, and treated by surgery. Since then, he had had no recurrence of symptoms. However, he visited us with a history of watery nasal discharge and was diagnosed as having recurrence of CSF leakage. Computed tomography showed a 20 mm-sized bone defect in the sphenoid sinus, suggesting CSF leakage through the bony defect. We performed craniotomy to close the defect of the sphenoid sinus with artificial dura mater and the fascia of the tensor fasciae latae muscle. The fistula was then closed with an artificial dura mater using the transsphenoidal sinus approach and the sphenoid sinus was filled with fat. After the operation, no recurrence of the CSF leakage was observed. Transcranial and transnasal endoscopic surgery was useful for closure of a large fistula in the deep skull base.
