Endoscopic nasal multilevel skull base reconstruction combined with lumbar cistern drainage in the treatment of infection caused by cerebrospinal fluid leakage: A case report

Abstract

Rationale: Traumatic cerebrospinal fluid leakage can cause complications such as meningitis, ventriculitis and brain abscess. It is necessary to formulate individualized treatment strategies, such as the use of antibiotics and skull base reconstruction methods. The application of nasal septum mucosal flap can significantly reduce the incidence of cerebrospinal fluid leakage. Neuroendoscope has been widely used in the treatment of skull base diseases, and the application of continuous lumbar cistern drainage technology has effectively controlled cerebrospinal fluid leakage. This paper introduces a case of long-term cerebrospinal fluid leakage complicated with infection. Neuroendoscopic multilevel skull base reconstruction combined with lumbar cistern drainage has achieved good clinical results, and this combined treatment is rarely reported in the literature. In order to promote the surgical effect of cerebrospinal fluid leakage, this combined treatment scheme is introduced here. Patient concerns: A 43-year-old male was admitted with headache for 7 days, aggravation with fever and vomiting for 2 days. Diagnoses: Cerebrospinal fluid culture suggests central nervous system infection, history and symptoms suggest traumatic cerebrospinal fluid rhinorrhea, and computed tomography (CT) shows old skull base fracture. Interventions: Intracranial infection was controlled after anti-infection treatment with sensitive antibacterial drug ceftriaxone sodium. Repair of cerebrospinal fluid rhinorrhea by transsphenoidal endoscope. Continuous lumbar cistern drainage (LCD) was performed after operation to promote the healing of the leak. Outcomes: After comprehensive treatment, the patient did not have CSF rhinorrhea again and was discharged. Lessons: Antibiotics combined with endoscopic multi-segment skull base reconstruction and lumbar cistern drainage are effective in treating infection caused by cerebrospinal fluid leakage.