title: [The repair of traumatic cerebrospinal fluid leak using temporal loose areolar connective tissue insertion into the frontal sinus and pericranial flap covering: a case report].
abstract: We report a case of cerebrospinal fluid (CSF) leak repair using loose areolar connective tissue insertion into the frontal sinus and pericranial flap covering. A 61-years-old man suffered from skull fracture including frontal sinus fracture in violence inflicted by others. Fifty days later, he presented rhinorrhea and pneumocephalus caused by a bone defect site of the frontal sinus and anterior skull base. We performed CSF leak repair with insertion of pedunculated loose areolar connective tissue into his frontal sinus, covering the leak point using pericranial flap. In general, frontal sinus obliteration has been accomplished with autologous grafts such as fat, muscle, or bone. These avascular grafts carry an increased risk of resorption and infection. The use of loose areolar tissue insertion into the frontal sinus was able to increase stability of the construct and caused no cosmetic troubles in our short follow up period. The combined use of these two autologous materials may be useful for repair of CSF leak from an anterior skull base fracture.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo-city, Hokkaido, Japan.
authors.forename: Yuuta
authors.initials: Y
authors.lastname: Kamoshima
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Terasaka
authors.forename: Shuji
authors.initials: S
authors.lastname: Hamauchi
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Kaneko
authors.forename: Hiroki
authors.initials: H
authors.lastname: Murakami
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery*; D003238:Connective Tissue / Q000637:transplantation*; D005626:Frontal Sinus / Q000293:injuries / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011007:Pneumocephalus / Q000209:etiology / Q000601:surgery; D012887:Skull Fractures / Q000150:complications / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous