Endoscope-Assisted Bilateral Supraorbital Craniotomies for Reconstruction of a Traumatic Cerebrospinal Fluid Leak in a Complex Skull Base Fracture: A Case Report
Toshiki Ishikura, Kentaro Horiguchi, Koichiro Maeda, Shinichi Origuchi, Yoshinori HiguchiAbstract
Background Surgical management of traumatic cerebrospinal fluid (CSF) leakage traditionally requires extensive craniotomy. Here, we present a tailored supraorbital craniotomy using an endoscopic technique for complex skull base trauma.
Methods We report the case of a patient with extensive anterior skull base fractures and persistent CSF rhinorrhea despite lumbar drainage.
Case Description A 21-year-old woman underwent surgery for worsening CSF rhinorrhea.
Results Bilateral supraorbital craniotomy was performed to bypass the midline fractures and reduce the risk of venous sinus injury. Endoscopic visualization revealed a fistula associated with brain herniation. Successful multilayered reconstruction was achieved using a split pericranial flap. The patient recovered without any recurrence of CSF leakage.
Conclusions Combining endoscopic visualization with customized craniotomy to avoid unstable fracture lines enables safe, robust, and effective repair of CSF leaks.