Congenital nasal cerebrospinal fluid fistula

A management protocol for congenital nasal cerebrospinal fluid fistulas is proposed based on our successful experience with a twice recurrent fistula: 1. Careful preoperative observation of the skin dimple for fluid leakage. 2. Transnasal radiographic contrast study. 3. Synchronous transnasal-transcranial excision of the fistula. 4. Obliteration of the excision site with primary soft-tissue closure and pericranial dural patching.