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Case Reports
. 2016 Jun;77(2):e89-93.
doi: 10.1055/s-0036-1584281.

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

Gabrielle A White-Dzuro  1 , Pouya Entezami  2 , George Wanna  3 , Paul Russell  3 , Lola B Chambless  1
Affiliations
Case Reports

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

Gabrielle A White-Dzuro et al. J Neurol Surg Rep. 2016 Jun.

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: CSF leak; cerebrospinal fluid fistulae; endoscopic endonasal approach; skull base repair.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflicts of interest concerning this article.

Figures

Fig.
Fig.
1 (A) Noncontrasted sagittal head CT and (B) noncontrasted coronal head CT obtained on admission showing obliteration of the left face, temporal bone, and orbit with a moderate amount of pneumocephalus. (C) Sagittal CT angiography showing anterior encephalocele and destruction of floor of anterior fossa. (D) Coronal head CT obtained on admission showing loss of floor of middle fossa.
Fig. 2
Fig. 2
(A, B) Planned incision with right-sided (R) standard bicoronal incision and left-sided (L) incision modified by retroauricular extension (arrow) to allow a combined frontal craniotomy with middle fossa craniotomy and mastoidectomy.
Fig. 3
Fig. 3
Noncontrasted axial head CT completed on POD 1 showing stable postoperative changes.
See this image and copyright information in PMC

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