Endoscopic Endonasal Repair of Cerebrospinal Fluid Leakage Caused by a Rare Traumatic Clival Fracture

• Published in: Neurologia medico-chirurgica Vol. 56; no. 2; pp. 81 - 84
• Main Authors: HIRAYAMA, Akihiro, KOMATSU, Fuminari, HOTTA, Kazuko, IMAI, Masaaki, ODA, Shinri, SHIMODA, Masami, MATSUMAE, Mitsunori
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2016; THE JAPAN NEUROSURGICAL SOCIETY
• Subjects: Aged, 80 and over; Case Report; Cerebrospinal Fluid Leak - diagnostic imaging; Cerebrospinal Fluid Leak - etiology; Cerebrospinal Fluid Leak - surgery; cerebrospinal fluid rhinorrhea; Cerebrospinal Fluid Rhinorrhea - diagnostic imaging; Cerebrospinal Fluid Rhinorrhea - etiology; Cerebrospinal Fluid Rhinorrhea - surgery; clival fracture; endoscopy; head trauma; Humans; Magnetic Resonance Imaging; Male; Multimodal Imaging; Skull Fractures - complications; Skull Fractures - diagnostic imaging; Skull Fractures - surgery; Tomography, X-Ray Computed
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.cr.2015-0152

An 89-year-old male presented with cerebrospinal fluid (CSF) rhinorrhea associated with head trauma sustained as a pedestrian in a traffic accident. Computed tomography (CT) showed pneumocephalus and multiple cranial bone fractures, including the clivus. Although the CSF rhinorrhea was treated conservatively for a week, clinical symptoms did not improve and surgical repair was performed. Preoperative thin-sliced bone CT and steady-state magnetic resonance images revealed a bone defect at the middle clivus and a collection of CSF fluid from the clival fistula in the sphenoid sinus. Endoscopic endonasal reconstruction was performed, and the 3-mm diameter dural tear and bone defect at the middle clivus were well visualized. The fistula was repaired using a pedicled nasoseptal mucosal flap. The CSF rhinorrhea completely disappeared as a result of the endoscopic endonasal surgery. The present report describes a rare case of CSF rhinorrhea caused by a traumatic clival fracture and surgical management by endoscopic endonasal surgery.