Endoscopic endonasal treatment of cerebrospinal fluid leak caused by clival fracture – a case report

Česká verzia

Authors: M. Májovský; D. Netuka; V. Masopust; V. Beneš
Authors place of work: Neurochirurgická a neuroonkologická klinika 1. LF a ÚVN Praha, prof. MUDr. V. Beneš, DrSc.
Published in the journal: Rozhl. Chir., 2015, roč. 94, č. 7, s. 297-300.
Category: Kazuistika

Summary

Introduction:
Clivus is a central structure of the skull base located in the vicinity of the brainstem and vital brain vessels. Clival fractures are usually caused by a high-energy trauma. Cerebrospinal fluid leak is one of the most common complications.

Case report:
A middle-aged male sustained a mild head trauma, followed by a nasal cerebrospinal fluid leak. CT scan revealed the massive pneumocephalus and the fracture of the clivus in the posterior wall of the sphenoidal sinus. We performed an endoscopic endonasal surgery to seal the defect.

Discussion:
Pneumatization of a sphenoidal sinus shows high variability. In the presented case, extreme pneumatization of the sinuses was combined with the gracile clivus, which was the predisposing factor for fracture. Traumatic cerebrospinal fluid leak carries the risk of intracranial hypotension and meningitis. Microscopic transseptal management is the classical surgical approach, while endoscopy provides the modern miniinvasive option.

Conclusion:
Endoscopic endonasal treatment of traumatic cerebrospinal fluid leak is the treatment of choice for the clival fractures.

Key words:
skullbase fracture – neurosurgery – endoscopy

Zdroje

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