J Korean Neurotraumatol Soc.  2009 Jun;5(1):33-36. 10.13004/jknts.2009.5.1.33.

Treatment of Delayed Cerebrospinal Fluid Rhinorrhea after Head Trauma: A Case Report

• Kang SH
• Hong WJ

• KMID: 2019932
• DOI: http://doi.org/10.13004/jknts.2009.5.1.33

Abstract

Most of cerebrospinal fluid (CSF) leakages after head trauma are presented within several days and improved by conservative management, although it often needs special procedure, such as lumbar drainage. However, sometimes surgeries are required if patients do not improve by non-surgical treatments. We have experienced one case of 20 year-old man undertaken two operations because of head trauma and nasal CSF leakage, which was presented 29 days after trauma and had not been cured by conservative management. In the operating field, we found the fistula from anterior fossa to nasal cavity. In order to seal the fistula, we used galea flap. We report this case with literature reviews.

Keyword

Cerebrospinal fluid rhinorrhea; Post-traumatic; Surgical treatment

MeSH Terms

Cerebrospinal Fluid Rhinorrhea
Craniocerebral Trauma
Drainage
Fistula
Head
Humans
Nasal Cavity

Figure

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  FIGURE 1 PreOP images. AC: Multiple skull fractures, basal skull fractures and facial bone fractures were shown on 3-dimensional computed tomography (CT) reconstruction. D, E: Brain CT demonstrated forehead swelling with pneumocephalus and epidural hematoma on the bifrontal areas. F: 3 hours after trauma hemorrhagic contusion was shown on frontal base.

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  FIGURE 2 PostOP images. A, B: After bilateral decompressive craniectomy, hemorrhagic contusion and swelling of both frontal lobes were shown on the CT.

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  FIGURE 3 CT images with CSF rhinorrhea. A: Brain CT scans taken 29 days after trauma show pneumocephalus on the frontal base. B: CT taken 55 days after trauma shows no interval change of pneumocephalus.

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  FIGURE 4 PostOP images. A, B: Skull anteriorposterior (AP) and lateral view of x-ray after reconstruction surgery with galeal frontalis myofascial flap and cranioplasty.

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