title: Traumatic epistaxis: Skull base defects, intracranial complications and neurosurgical considerations.
abstract: BACKGROUND
  Endonasal procedures may be necessary during management of craniofacial trauma. When a skull base fracture is present, these procedures carry a high risk of violating the cranial vault and causing brain injury or central nervous system infection.
  
  
  METHODS
  A 52-year-old bicyclist was hit by an automobile at high speed. He sustained extensive maxillofacial fractures, including frontal and sphenoid sinus fractures (Fig. 1). He presented to the emergency room with brisk nasopharyngeal hemorrhage, and was intubated for airway protection. He underwent emergent stabilization of his nasal epistaxis by placement of a Foley catheter in his left nare and tamponade with the Foley balloon. A six-vessel angiogram showed no evidence of arterial dissection or laceration. Imaging revealed inadvertent insertion of the Foley catheter and deployment of the balloon in the frontal lobe (Fig. 2). The balloon was subsequently deflated and the Foley catheter removed. The patient underwent bifrontal craniotomy for dural repair of CSF leak. He also had placement of a ventriculoperitoneal shunt for development of post-traumatic hydrocephalus. Although the hospital course was a prolonged one, he did make a good neurological recovery.
  
  
  CONCLUSIONS
  The authors review the literature involving violation of the intracranial compartment with medical devices in the settings of craniofacial trauma.
  
  
  CONCLUSIONS
  Caution should be exercised while performing any endonasal procedure in the settings of trauma where disruption of the anterior cranial base is possible.
authors.affiliation: Stanford Hospitals and Clinics, Department of Neurosurgery, 300 Pasteur Drive, R200/MC:5826, Stanford, CA 94305, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.forename: Richard
authors.initials: R
authors.lastname: Joseph
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lober
authors.forename: Cassie
authors.initials: C
authors.lastname: Ludwig
authors.forename: Roland
authors.initials: R
authors.lastname: Torres
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
keywords: Epistaxis; Foley catheter; Intracranial; Nasogastric tube; Skull base fracture