title: [A successfully treated case of cerebrospinal fluid fistula caused by fracture of the sella turcica].
abstract: Fracture of the sella turcica is rare and is associated with many complications. We successfully treated a cerebrospinal fluid fistula caused by a fracture of the sella turcica. A 66-year-old male in a motor vehicle accident was admitted to an outside hospital with disturbance of consciousness. A computed tomography (CT) scan of the head revealed a subarachnoid hemorrhage and pneumocephalus. Cerebrospinal fluid rhinorrhea developed after admission. Repair of the fistula was attempted without success, and the patient was transferred to our hospital for further examination and treatment. A fracture of the sella turcica was clearly visualized on coronal and sagittal head CT and on a three-dimensional reconstructed CT (3D-CT) image. The source of the CSF fistula was thought to be the anterior wall of the sella turcica. Through a bifrontal interhemispheric approach, the cerebrospinal fluid fistula was repaired microscopically with the assistance of endoscopy. Postoperatively, the fistula stopped completely. Coronal and sagittal head CT and 3D-CT images are useful for making a diagnosis of CSF leakage. Endoscopic images can assist in observation of the dead angle of the microscope.
authors.affiliation: Department of Neurosurgery, Yamagata University School of Medicine, 2-2-2 Iidanishi, Yamagata-city, Yamagata 990-9585, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kuge
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kinjo
authors.forename: Takamasa
authors.initials: T
authors.lastname: Kayama
mesh_terms: D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D012658:Sella Turcica / Q000293:injuries*; D012887:Skull Fractures / Q000150:complications* / Q000601:surgery; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014057:Tomography, X-Ray Computed