2022 Volume 47 Issue 4 Pages 395-400
Collagen matrix (DuraGen®, Integra Neurosciences) is often used because it does not require suturing; thus, it can be easily manipulated. We report the case of a 6-year-old boy who developed cerebrospinal fluid (CSF) rhinorrhea due to trauma and had a good outcome after using DuraGen® to close a fistula. He fell while riding a bicycle and injured his face, and was urgently taken to his previous doctor. Brain computed tomography (CT) detected a fracture of the inner plate of the frontal sinus and traumatic subarachnoid hemorrhage, and the patient was transferred to our hospital. He continued receiving conservative treatment and was discharged on the 12th day after the injury. However, late-onset CSF rhinorrhea was observed, and given that the symptoms did not improve, he was admitted to the hospital for treatment approximately 2 months after the injury. After hospitalization, lumbar drainage was performed. There were no findings suggestive of meningitis in the CSF examination; therefore, conservative management was maintained. However, it was determined that he could not be maintained at rest and fistula closure did not occur; thus, we decided to perform surgical treatment. Regarding the operation, we approached from the epidural, and found the dura mater and brain parenchyma incarcerated in the fractured part at the base of the anterior skull base. The dura deficit was closed using DuraGen® and the bone deficit was closed using a periosteal pedicle flap. Subsequently, he was discharged from the hospital without any apparent CSF rhinorrhea, and the postoperative course was uneventful even in the outpatient department approximately 3 months after the operation. Although DuraGen® should be used with caution at the site of infection or suspected infection, in this case, it was used without any apparent signs of infection. The dura is very fragile in children, and traditional dural reconstruction methods can result in incomplete sutures. However, by using DuraGen®, non-watertight dural reconstruction can be performed without suturing. DuraGen® is considered to be safe and effective even in cases of children with traumatic CSF rhinorrhea with no findings of meningitis, especially when suture failure is expected.
