title: Endoscopic Endonasal Repair of Cerebrospinal Fluid Leakage Caused by a Rare Traumatic Clival Fracture.
abstract: An 89-year-old male presented with cerebrospinal fluid (CSF) rhinorrhea associated with head trauma sustained as a pedestrian in a traffic accident. Computed tomography (CT) showed pneumocephalus and multiple cranial bone fractures, including the clivus. Although the CSF rhinorrhea was treated conservatively for a week, clinical symptoms did not improve and surgical repair was performed. Preoperative thin-sliced bone CT and steady-state magnetic resonance images revealed a bone defect at the middle clivus and a collection of CSF fluid from the clival fistula in the sphenoid sinus. Endoscopic endonasal reconstruction was performed, and the 3-mm diameter dural tear and bone defect at the middle clivus were well visualized. The fistula was repaired using a pedicled nasoseptal mucosal flap. The CSF rhinorrhea completely disappeared as a result of the endoscopic endonasal surgery. The present report describes a rare case of CSF rhinorrhea caused by a traumatic clival fracture and surgical management by endoscopic endonasal surgery.
authors.affiliation: Department of Neurosurgery, Tokai University Hachioji Hospital.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirayama
authors.forename: Fuminari
authors.initials: F
authors.lastname: Komatsu
authors.forename: Kazuko
authors.initials: K
authors.lastname: Hotta
authors.forename: Masaaki
authors.initials: M
authors.lastname: Imai
authors.forename: Shinri
authors.initials: S
authors.lastname: Oda
authors.forename: Masami
authors.initials: M
authors.lastname: Shimoda
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsumae
mesh_terms: D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D012887:Skull Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed