Endoscopic endonasal approach transsphenoidal repair of a defective skull base in a CSF leak-infected patient: The first case at Phrapokklao hospital, Chanthaburi province

Abstract

Cerebrospinal fluid leaks are rare conditions but can be life-threatening. They can lead to dangerous complications, such as meningitis and brain abscess. Cerebrospinal fluid leaks can be divided into three main causes: Trauma or surgery: This includes head accidents or surgeries involving the skull base or sinus area, such as sinus surgery that penetrates the base of the skull, failed skull base repair surgery, and post-operative complications. Non-traumatic causes: These can be caused by conditions like tumors that have spread to the base of the skull. Unknown causes: In some cases, the cause of a cerebrospinal fluid leak remains unknown. This case report describes a cerebrospinal fluid leak at the base of the skull caused by a head injury from a fall. The patient experienced cerebrospinal fluid leaking from their nose and throat. The leak eventually led to an abscess in the sphenoid sinus and cavernous sinus. The patient underwent endoscopic endonasal approach (EEA) surgery to remove the abscess and administer intravenous antibiotics for fourteen days. A second EEA procedure was performed to repair the leak using a naso-septal flap and free tissue graft from the fascia lata. The surgery was successful, and the patient recovered without complications. This is the first reported case at Phrapokklao Hospital in Chanthaburi Province where a cerebrospinal fluid leak was treated using this method.