Post traumatic CSF Rhinorrhea, Pnemo-cephalous and skull base repair

     Trivial looking head trauma due to fall from skidding bike.

     This young man got admitted for intense headache and watery discharge from right nose. Watery discharge is nothing but CSF leak suggesting skull base injury.

    CT cysternography revealed collection of dye in rt sphenoid with air in extradural space but no obvious fracture.

     Surgery was planned after covid testing. The plan was to identify the leak, closure and sos burr hole to drain the air.

      Endoscopic transnasal sphenoidotomy done and mucosa stripped off from the sinus cavity. There was evident undisplaed fracture in rt para-sellar region extending to planum sphenoidale.  There was no scope for plugging the defect with fat, hence glue applied directly on fracture line with fat, fascia as onlay graft and middle turbinate incised at the ant end, rotated and placed as pedicle graft. One sided nose packed with Ivalon for a week.
         In post op there was no leak, headache relieved and CT scan on 5 th post-op showing significantly resolved pnemocephalous extradural space.
Pre-op :CT Cysternography showing pnemo-cephalous

Post-op,:  resolving pnemo-
cephalous

Comments

Post a Comment

Popular posts from this blog

The paperweight

The paperweight !🧊         This kind of stories  we often read in readers digest, newspapers or story books. However sometimes pleasant surprises do happen, even in our very own life.                 Last year, a young man visited my Out-Patient Department [ OPD ]. Actually I saw this well dressed gentleman sitting in the corner of my waiting room when I came to clinic after completing indoor patient's rounds. The attendant at the OPD conveyed the visitor's wish to meet me. I was a bit reluctant at first looking at the long list of waiting patients and a couple of surgeries scheduled in the afternoon.            Nonetheless, I got some time between appointments and called this gentleman. He walked in with a vibrant smile and sat in front of me. There was some silence to start with, we both were observing each other and I had a feeling that I had seen him somewhere but my memory was once again deceiving me as usual.  He put his one hand in his pocket and slowly pulled out a
Read more

Spontaneous CSF leak

     Last week operated a challenging case of spontaneous CSF leak in a 40 yr old young lady. She is an avid Kathak dancer and recently had gone for snorkeling. Severe headache with profuse watery discharge from nose and physicians rightly suspected it to be a case of Meningitis with CSF rhino-rhea [Brain fluid leaking into nasal passage through a defect in skull base].     Thoroughly investigated, done CT cysternogrphy and found the suspicious defect in sphenoid sinus. I myself with Dr Chandrashekhar an eminent neurosurgeon performed the surgery. It was endoscopic trans nasal surgery, defect was identified in sphenoid clivus as multiple tiny leaks in a localised area c,w some drilling done with diamond bur to make a single defect good enough to be plugged with fat , with overlay  fascia lata and glue in a five layer closure. Pack was removed on 7th post op day and pt is discharged . This is a very rewarding minimally invasive surgery for a grave problem.      However this lady wil
Read more