title: Endoscopic repair technique for traumatic penetrating injuries of the clivus.
abstract: Unlike basilar skull fractures, penetrating traumatic injuries to the clivus are uncommon. We present two novel and interesting cases of traumatic crossbow arrow injury and penetrating screwdriver injury to the clivus. A review of the literature describing methods to repair these injuries was performed. A careful, systematic approach is required when working up and treating these injuries, as airway preservation is critical. An adaptation to the previously described "gasket-seal" method for skull base repair was utilized to repair the traumatic cerebrospinal fluid (CSF) fistulas. This repair technique is unique in that it is tailored to a much smaller defect than typical post-surgical defects. Two patients are presented, one with a post-traumatic CSF fistula after penetrating crossbow injury to the clivus and one with a penetrating screwdriver injury to the clivus. The patients were treated successfully with transnasal endoscopic repair with fascia lata graft and a nasoseptal flap, a novel adaptation to the previously described "gasket-seal" technique of skull base repair.
authors.affiliation: Department of Neurological Surgery, Houston Methodist Neurological Institute, 6560 Fannin Street, #944, Houston, TX 77030, USA. Electronic address: bdliebelt@houstonmethodist.org.
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Liebelt
authors.affiliation: Department of Neurological Surgery, Houston Methodist Neurological Institute, 6560 Fannin Street, #944, Houston, TX 77030, USA.
authors.forename: Zain
authors.initials: Z
authors.lastname: Boghani
authors.affiliation: Department of Neurological Surgery, Houston Methodist Neurological Institute, 6560 Fannin Street, #944, Houston, TX 77030, USA.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Haider
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Takashima
mesh_terms: D000328:Adult; D003388:Cranial Fossa, Posterior / Q000293:injuries / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013524:Surgical Flaps / Q000009:adverse effects; D014950:Wounds, Penetrating / Q000601:surgery*
keywords: CSF fistula; Clivus; Endoscopic; Skull base repair; Trauma