title: Endoscopic transpterygoidal repair of a large cranial defect with cerebrospinal fluid leak in a patient with extensive osteoradionecrosis of the skull base: case report and technical note.
abstract: BACKGROUND
  Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa.
  
  
  METHODS
  A 37-year-old male patient presented with multiple areas of cranial defect with cerebrospinal fluid leak due to osteoradionecrosis following radiation for nasopharyngeal carcinoma 4 years earlier. Clinical examination showed involvement of all cranial nerves except the IInd and XIth nerves on the left side. A prior attempt to repair the cerebrospinal fluid leak with craniotomy was not successful.
  
  
  CONCLUSIONS
  This case demonstrates the successful endoscopic repair of a large cranial defect with cerebrospinal fluid leak.
authors.affiliation: Department of Otorhinolaryngology,University of Malaya,Kuala Lumpur,Malaysia.
authors.forename: Y
authors.initials: Y
authors.lastname: Brand
authors.affiliation: Department of Otorhinolaryngology,University of Malaya,Kuala Lumpur,Malaysia.
authors.forename: E
authors.initials: E
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery,University of Malaya,Kuala Lumpur,Malaysia.
authors.forename: V
authors.initials: V
authors.lastname: Waran
authors.affiliation: Department of Otorhinolaryngology,University of Malaya,Kuala Lumpur,Malaysia.
authors.forename: N
authors.initials: N
authors.lastname: Prepageran
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009296:Nasal Cavity / Q000601:surgery; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000175:diagnosis / Q000601:surgery*; D056739:Pterygopalatine Fossa / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Cerebrospinal Fluid Leak; Middle Cranial Fossa; Osteoradionecrosis; Sphenoid Bone