Background: Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition
that still presents a major challenge in terms of its diagnosis and management.
It is estimated that meningitis develops in approximately 10%–25% of patients with this
disorder, and 10% of them die as a result. Approximately 80% of all cases of CSF
rhinorrhea are caused by head injuries that are associated with cranial fractures.
Objective: To evaluate the technique and perioperative management for cerebrospinal
fluid (CSF) leak following anterior skull base fracture via extradural anterior skull base
approach.
Methods: This study was conducted at the department of Neurosurgery of Benha
University hospitals, Egypt from June 2024 to December 2024. Patients with posttraumatic CSF rhinorrhea occurred after extensive anterior skull base fracture managed
surgically via extended extradural anterior skull base approach were included in this
study. The data of medical and radiological records, surgical approaches, repair
techniques, perioperative management, surgical outcome and postoperative follow up
were analyzed. Patients were followed up for the outcome of CSF leak and
postoperative complications. Data were presented as frequency and percent.
Results: Twenty-five patients were included in this study. The patients’ mean age was
41.5 years (range 30-53 years). Seven patients were operated within 2 weeks; while the
remaining 18 patients, with prolonged or recurrent CSF rhinorrhea, received the repair
surgery at 2 weeks to 3 weeks after the initial trauma. The mean overall length of followup was 6 months. All the patients suffered from anterior skull base multiple fractures.
The main surgical repair aimed to achieve watertight seal of the dura. The frontal pericranial flap alone was used in 14 patients, combined with temporalis muscle and/or its
fascia in 8 patients. Free fascia Lata graft was used instead in the rest 3 patients. No
CSF leak was found in all the patients at discharge. There was no mortality in this series.
Bilateral anosmia was the most common complication. At follow-up, recurrent CSF leak
occurred in 3 cases or postoperative infection occurred in 2 cases.
Conclusion: Traumatic CSF rhinorrhea with extensive anterior skull base fractures often
Extended extradural anterior skull base
approach for management of post-traumatic
cerebrospinal fluid rhinorrheaneeds aggressive treatment via extended intracranial extradural approach. Vascularized
tissue flaps are good grafts for anterior cranial base reconstruction, either alone or in
combination with temporalis muscle and its fascia, also fascia Lata sometimes can be
used as free autologous graft. The approach is usually reserved for patients with posttraumatic CSF rhinorrhea in anterior skull base injuries. |
