Brain sag as a cause of postoperative neurological deterioration following anterior cranial fossa floor repair for post traumatic cerebrospinal fluid rhinorrhoea.
A patient with posttraumatic CSF rhinorrhoea underwent a transcranial anterior skull base repair, with a lumbar drain being inserted at induction of anaesthesia. Postoperative neurological deterioration occurred due to brain sag. Following treatment, there was significant recovery albeit in a slow and steady fashion. Patients with brain sag as a result of lumbar drain insertion can make a good recovery, despite an initial presentation with signs of severe brainstem compression, which could easily be misinterpreted as having a poor prognosis. Absence of an initial dramatic response to treatment does not necessarily imply poor outcome in the long term.
Kamat
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Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, South Yorkshire, UK. Abhinay.Kamat@sth.nhs.uk
Bhattacharyya
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Carroll
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D000328:Adult; D001927:Brain Diseases / Q000601:surgery; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D035262:Cranial Fossa, Anterior / Q000601:surgery; D004322:Drainage / Q000009:adverse effects*; D005402:Fistula / Q000601:surgery; D020197:Head Injuries, Penetrating / Q000601:surgery; D018475:Head-Down Tilt; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D013997:Time Factors