Surgical management of traumatic cerebrospinal fluid fistulas with associated lesions.

Abstract

Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula. In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus. Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases. Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.