title: Single Operation to Repair Multifocal Cerebrospinal Fluid Fistulae Following Gunshot Wound: A Case Report.
abstract: Introduction Traumatic cerebrospinal fluid (CSF) fistulae can be a challenging neurosurgical disease, often requiring complicated surgical intervention. Case Presentation A 54-year-old man presented with a gunshot wound to the head with complex injury to the skull base and significant CSF leakage from multiple sites. A single surgery was performed using a combined Neurosurgery, Neurotology, and Rhinology team, which was successful in repairing the multiple skull base defects and preventing further CSF leak. Discussion Trauma to the skull base is a common inciting factor for the development of CSF fistulae. Endoscopic approaches are often preferred for repairing these defects, but craniotomy remains a viable option that may be required in more complex cases. A combined approach has not been described previously, but was successful for this severe multifocal defect. Conclusion A multidisciplinary approach allowed for a combined intervention that addressed both the anterior and middle fossae fistulae simultaneously. This limited the potential infectious complications of continued CSF leak and allowed for early rehabilitation.
authors.affiliation: Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, United States.
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: White-Dzuro
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, New York, United States.
authors.forename: Pouya
authors.initials: P
authors.lastname: Entezami
authors.affiliation: Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, United States.
authors.forename: George
authors.initials: G
authors.lastname: Wanna
authors.affiliation: Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Russell
authors.affiliation: Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, United States.
authors.forename: Lola B
authors.initials: LB
authors.lastname: Chambless
keywords: CSF leak; cerebrospinal fluid fistulae; endoscopic endonasal approach; skull base repair