Bakht Zada, Mumtaz Ali, Ajmal Hussain, Muhammad Said, Khurshid Anwar.
Management of post traumatic CSF fistulae.
Pak J Otolaryngol Jan ;22(1):13-5.

It is prospective study of 37 cases of post-traumatic CSF fistulae that needed neurosurgical repair. The study was conducted in the Neurosurgery and ENT Units of PGMI /Lady Reading Hospital and PGMI Hayatabad Medical Complex, Peshawar during six years duration from April 1999 to April 2005. There were 32 male and 5 female patients with age range from 9 months to 55 years. Thirty-three (33) cases were of road traffic accident, 3 cases had received firearm injuries while 1 patient was a case of homicidal physical assault. One case had CSF otorrhoea, had CSF orbitorrhoea whereas all the rest of 35 cases had CSF rhinorrhoea. All 37 cases got their routine x-ray skull and CT scan done whereas MRI was done in 3 cases only. Frontal, orbital, temporal and ethmoid bone fractures were the common radiological findings. Fracture of frontal sinuses only occurred in 3 cases whereas isolated ethmoid bone fracture was found in 2 cases only. In 11 patients primary dural repair was performed. Out of remaining 26 patients bone wax and spongeston was used to patch the bony defect whereas the rest of 23 cases needed fascialata, pericranium and temporalis fascia as graft material. In 34 cases immediate stoppage of CSF was noticed while in 2 (5.4 %) cases additional lumber punctures were done to facilitate repair. One patient failed to heal and is still having recurrent leak. Surgical mortality was none in this study. Wound infection was also observed in none of the patients. Five patients developed loss of smell sensation postoperatively.

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