title: Successful closure of recurrent traumatic csf rhinorrhea using the free rectus abdominis muscle flap.
abstract: BACKGROUND
  We present two patients in whom a free rectus abdominis muscle flap was used to close recurrent traumatic CSF rhinorrhea.
  
  
  METHODS
  CT scan of both patients showed frontal lobe atrophy and porencephaly after contusional hematoma. In the first patient, because the site of CSF leakage was not identified and the patient underwent three unsuccessful attempts to close the fistula using the fascia lata, we treated the patient by unifying all paranasal sinuses and by filling them with a free rectus abdominis muscle flap. In the second patient, CSF rhinorrhea recurred 6 years after closure of the fistula using the fascia lata. The patient underwent separation of a porencephalic cyst from the paranasal sinus and a free muscle flap was placed extradurally, because the CSF pulse pressure in the enlarged left anterior horn eroded the previously repaired fascia lata, resulting in the recurrence of CSF leakage.
  
  
  CONCLUSIONS
  Although duraplasty is the primary procedure for repairing dural fistulas, the vascularized free muscle flap is an alternative method when the location of the fistula is not identified or the patient with recurrent CSF rhinorrhea has severe frontal lobe atrophy and porencephaly.
authors.affiliation: Department of Neurosurgery, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tokoro
authors.forename: S
authors.initials: S
authors.lastname: Fujii
authors.forename: A
authors.initials: A
authors.lastname: Kubota
authors.forename: I
authors.initials: I
authors.lastname: Yamamoto
authors.forename: J
authors.initials: J
authors.lastname: Maegawa
authors.forename: M
authors.initials: M
authors.lastname: Saijo
authors.forename: T
authors.initials: T
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000150:complications* / Q000601:surgery; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed