Multidisciplinary surgical approach for cerebrospinal fluid leak in children with complex head trauma

Gadi Fishman, Dan M. Fliss, Shlomi Benjamin, Nevo Margalit, Ziv Gil, Ari Derowe, Shlomi Constantini, Liana Beni-Adani

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Introduction: Post-traumatic cerebrospinal fluid leak from the anterior cranial fossa in children may be isolated or combined with severe facial and calvarial injury. Untreated leak may result with meningitis, hydrocephalus, and abnormal neurocognitive development. Patients and methods: We present nine children, ages 4-16 years, with complicated craniofacial injury treated by a combined subcranial and intracranial approach. A continuous lumbar drainage was kept for several days, and prophylactic antibiotics and anti-convulsive medications were routinely given. A multidisciplinary approach including discussion before surgery about other surgical options (endoscopic extracranial and intracranial alone) were performed. Results: None of the operated children had episodes of meningitis/leak after the combined approach, suggesting that appropriate sealing of the base of the skull has been achieved. There was no mortality, and the long-term follow-up showed good developmental and cosmetic results. Most of the children had significant brain contusions prior to surgery; however, these did not progress as minimal retraction was enabled by the extensive subcranial and intracranial approach. Conclusions: Child's age, anatomy of the bone, extent of cranial injury, and clinical parameters should be seriously considered when choosing the technical methods as for sealing base of skull and reconstruction of facial/cranial bones. Young age does not seem to be a contraindication to the combined approach, thus, we recommend considering it in extensive base of skull fractures when concomitant cranial, maxillofacial, and orbital fractures coexist, as alternative options may not suffice in these cases.

Original languageEnglish
Pages (from-to)915-923
Number of pages9
JournalChild's Nervous System
Issue number8
StatePublished - 1 Aug 2009
Externally publishedYes


  • Base of skull
  • CSF leak
  • Combined extracranial-intracranial approach
  • Craniofacial trauma
  • Craniotomy
  • Fractures
  • Pediatric head trauma
  • Reconstruction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology


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