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

• Main Authors: Gabrielle A. White-Dzuro, Pouya Entezami, George Wanna, Paul Russell, Lola B. Chambless
• Format: Article
• Language: English
• Published: Georg Thieme Verlag KG 2016-06-01
• Series: Journal of Neurological Surgery Reports
• Subjects: cerebrospinal fluid fistulae; csf leak; endoscopic endonasal approach; skull base repair
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1584281

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.