Closure of clival cerebrospinal fluid fistula with biocompatible osteoconductive polymer

Cerebrospinal fluid fistula into the upper airway often results in meningitis. Closure of fistulas is usually effective using conventional surgical techniques to reconstruct the defect. We report a case of cerebrospinal fluid fistula into the sphenoid sinus and nasopharynx secondary to resection of a clivus chordoma that resisted conventional attempts at closure, including a rectus abdominus free flap. Closure of the fistula was accomplished with the use of a novel alloplast, biocompatible osteoconductive polymer. Follow-up for more than 1 year shows no evidence of rejection, infection, or recurrent cerebrospinal fluid rhinorrhea.