[A case of traumatic cerebrospinal fluid rhinorrhea manifested ten years after head injury]

In patients with head injury, the total incidence of CSF rhinorrhea was 1 - 3%, and in almost all cases, CSF rhinorrhea occurred within the first three months after injury. We report here a case of a 26 year-old male with CSF rhinorrhea manifested with meningitis who had once been admitted to hospital 10 years previously with a head injury. He had a fracture which we thought had caused a CSF leakage in the left frontal skull base. After conservative treatment for a month we eventually undertook bifrontal craniotomy and repaired the cleft of the skull base with dura and fibrin. In cases in which CSF rhinorrhea had occurred more than 10 years after head injury, including several reports in Japan, surgical treatment had always been required. We think bifrontal craniotomy should be performed in such cases in which it is difficult to locate a cleft in the skull base before the operation. The field of view is wider during the intradural approach. To restore an area with a lack of dura, highly anti-infectionary convexity dura is used a lot, and it is also thought that fibrin is effective in dural repair. The dural deficient areas take 3 to 4 months to repair perfectly, and postoperative observation of the patient's progress is required.