An International Journal of Otorhinolaryngology Clinics

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VOLUME 11 , ISSUE 1 ( January-April, 2019 ) > List of Articles

CASE REPORT

Surgical Management of Traumatic Cerebrospinal Fluid Fistula in a Child with Recurrent Meningitis

Lília Ferraria, Sílvia Alves, Nélia Ferraria, Mário Santos, Helena Rosa

Keywords : Extracranial approach, Pediatric trauma, Recurrent meningitis, Skull base defects,Cerebrospinal fluid leaks

Citation Information : Ferraria L, Alves S, Ferraria N, Santos M, Rosa H. Surgical Management of Traumatic Cerebrospinal Fluid Fistula in a Child with Recurrent Meningitis. Int J Otorhinolaryngol Clin 2019; 11 (1):15-18.

DOI: 10.5005/jp-journals-10003-1332

License: CC BY-NC 4.0

Published Online: 00-04-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: To report a case of a child with recurrent meningitis in which cerebrospinal fluid (CSF) leak diagnosis was established and treated by an extracranial approach. Background: The diagnosis and management of pediatric posttraumatic CSF leak can be challenging. Untreated leaks can be manifested by intermittent rhinorrhea or recurrent meningitis, which can be the only form of presentation. Case description: A 15-year-old girl had a past medical history of a fall from the second floor at the age of 8, which resulted in traumatic frontal sinus fracture. She had her first episode of pneumococcal meningitis at the age of 14 which led to the diagnosis of posttraumatic CSF fistula. External surgery was performed to repair the fistula, with no evidence of CSF rhinorrhea on postoperative examination. She was readmitted at the age of 15 years for a new episode of pneumococcal meningitis. The high-resolution computed tomography scan revealed an anterior and posterior wall defect of the right frontal sinus. An extracranial approach was performed with visualization of CSF trickling through the defect. Dural regeneration matrix and fascial graft were positioned on the defect, and fibrin glue was used. Frontal sinus obliteration was performed using hydroxyapatite with success. Conclusion: The basic principles of pediatric CSF fistulas repair, such as an adequate exposure of the defect, do not differ from those of the adults. The successful repair of CSF leaks results in a preoperative correct identification of the fistula and bone defect site, an accurate knowledge of reconstruction techniques, and their judicious application in the procedure planning. Clinical significance: This report documents a case of a child with recurrent meningitis as the only symptom of a CSF fistula as a consequence of a traumatic fall 7 years earlier. The CSF leaks’ etiology, current diagnostic techniques, and surgical management are discussed.


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