Right Nasoethmoidal Cerebrospinal Fluid Leak

Abstract

The cerebrospinal fluid leak is a frequent pathology in neurosurgery, its etiology is diverse, from traumatic to congenital lesions, becoming a surgical challenge, since despite the existence of a variety of approaches, the choice and realization of one of them will depend on different factors such as: location, defect size, etiology, hospital stay, among others. However, the choice and implementation of any approach does not guarantee the total eradication of the problem; for this case, we have selected the case of a 43-year-old female patient who arrived at the emergency neurosurgery service, with the classic symptoms of hyaline rhinorrhea and headache, a predominant symptom in this pathology; after receiving cranial trauma secondary to an impact with a soccer ball. The transciliar approach being decided as an appropriate option taking into account the factors already mentioned, being this more conservative with respect to other transcranial ones therefore it is one of the most important elements in this case. The transciliar approach consists in making an incision on the right eyebrow until the lateral end of it, dissecting by planes until reaching the skull. Then a hole is made 1 cm lateral to the midline with a drill, observing dura mater and frontal sinus, osteoplastic craniotomy of ± 1.5 x 4 cm in length is performed. The dura mater is observed where durotomy is performed based on the orbito-frontal region. The evolution of the patient was satisfactory, without persisting of the leak one year after the procedure.

Keywords

Headache, Leak, Neurosurgery