Abstract
We basically perform an operative repair to patients with persistent traumatic leakage of cerebrospinal fluid (CSF) with conservative treatment and most of the cases that we have experienced are repaired successfully. However, recurrent CSF leakage may still rarely be seen. We report on a case of a 61-year-old male with dialysis who fell down the stairs, and had skull fractures including the sphenoidal and frontal sinuses. Although we observed the patient in the semi-fowlers position on the bed with administration of antibiotics, he had meningitis and the CSF leakage did not stop. We performed CSF leakage repair with multi-layer sealing surgery using fat and fascia in the initial operation. CSF leakage recurred a week after surgery, when the packing gauzes were taken out. Obliteration was then accomplished with a pedicled nasal septal flap (PNSF) at the second operation. He could go home 43 days after surgery without CSF leakage, meningitis, or any complications. These results suggest that an avascular reconstruction technique was not sufficient to repair damage in a patient not in good overall condition, such as patients on dialysis. We have to consider what kind of reconstructive options are adequate for each patient. Also from this case, we could verify the usefulness of a navigation system during endoscopic skull base surgery, to make the PNSF and to reconstruct the skull base.
