Recurrent cerebrospinal fluid leaks and bacterial meningitis in complex posttraumatic dural-lymphatic skull-base malformation after craniocerebral injury in childhood

Abstract

A 45-year-old woman was presented in our hospital after at least ten episodes of bacterial meningitis with and without simultaneous CsF leaks. previously, she has had 12 operations involving the nose, paranasal sinuses and frontal skull base due to a known posttraumatic skull base malformation located in the sphenoid sinus and cavernous sinus after head trauma in early childhood (overview of the available information in Fig. 1). Five years before visiting our hospital, two large parasellar and temporobasal liquor accumulations as well as several smaller osseous CsF leaks in the posterior wall and ground of the left sphenoid and maxillary sinus had been described. the liquor seemed to be transported longitudinally along the nerve sheaths which could be observed via intrathecal fluorescein imaging. Following the last neurosurgical operation, there was no doubt that the left cavernous sinus was filled with arachnoidea and liquor and was surrounded by very filmy, perforated bone with diaphanous trigeminal branches. In further histopathological analysis of mucosa, untypically distended lymphatic vessels without direct detection of liquor were provided, so that a complex dural-lymphatic fistula of the skull base was probable. After the tenth meningitis, following a 5-year meningitis-free period, our patient had another recurrent meningitis and accordingly a need for restaging to repair damage and avoid recurrence of meningitis. We began by Ctand MRimaging of the head focusing on the skull base. After this proved ineffective, we conducted an interdisciplinary radiological conference to find additional strategies. We started Introduction