台耳醫誌

The incidence of post-traumatic cerebrospinal fluid (CSF) leakage after blunt head injury ranges from 2% to 4%. About 80% of leaks occur within 48 hours after the injury, and 95% manifest in 3 months. Conservative measures are effective in approximately 60%-70% patients with traumatic CSF leaks. However, if leaks persist, surgical intervention is needed. Here, we have presented our experience with a case of traumatic sphenoid sinus fracture complicated by CSF leakage and pneumocephalus. The patient was managed conservatively by a neurosurgeon, but CSF leakage persisted. Therefore, transnasal endoscopic repair was performed 8 days after the trauma. After enlarging the left sphenoid sinus natural ostium, a small defect was identified at the posterior wall of the left sphenoid sinus. Bone chips and the surrounding detached mucoperiosteum were removed, and the basilar artery was visible through the defect. The bath-plug technique using the fat tissue obtained from the abdomen was applied to repair the defect. Then, a free mucosal graft harvested from the left nasal septum was used to cover the fat plug and defect area. A TISSEEL fibrin sealant was used. The left sphenoid sinus cavity was packed with Gelfoam®. The patient recovered well after surgery. There was no recurrence of CSF leakage thereafter.
(J Taiwan Otolaryngol Head Neck Surg 2021; 56:181-185)