J Neurol Surg Rep 2016; 77(02): e89-e93
DOI: 10.1055/s-0036-1584281
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Single Operation to Repair Multifocal Cerebrospinal Fluid Fistulae Following Gunshot Wound: A Case Report

Gabrielle A. White-Dzuro
1  Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, United States
,
Pouya Entezami
2  Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
,
George Wanna
3  Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, United States
,
Paul Russell
3  Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, United States
,
Lola B. Chambless
1  Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, United States
› Author Affiliations
Further Information

Publication History

31 December 2015

18 April 2016

Publication Date:
09 June 2016 (online)

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.