Cerebrospinal Fluid Leak Repaired with Nasoseptal Flap in a 2-Week-Old Neonate

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Workman, Alan D., Ivy W. Maina, Vasiliki Triantafillou, James N. Palmer, Nithin D. Adappa, Phillip B. Storm, and Jordan T. Glicksman


Background Congenital encephalocele associated with cerebrospinal fluid (CSF) leak requires prompt surgical management to prevent infection and other complications. Endoscopic techniques are increasingly utilized to repair skull base defects in young pediatric patients, but there is controversy in the literature regarding the use of a pedicled nasoseptal flap in this population.

Methods Case report of a novel age group application for nasoseptal flap and review of the literature.

Case Report A neonate with a congenital frontoethmoidal encephalocele underwent surgical excision of the mass and sutured repair of CSF leak at postnatal day 10. Brisk CSF rhinorrhea was again noted 5 days postoperatively and the patient returned to the operating room on postnatal day 16 for endoscopic repair of the skull base defect with a pedicled nasoseptal flap. Imaging in the following weeks demonstrated a viable graft without recurrence of CSF leak.

Discussion This neonate is the youngest reported patient to undergo nasoseptal flap repair of a skull base defect. Previous groups have suggested that patients below a specified age would not have sufficient nasoseptal tissue to provide adequate coverage of the leak site. We demonstrate that this is a feasible technique to achieve a stable repair, even in the first few days of life. As endoscopic surgical repair is associated with significantly less morbidity than comparable open repairs, an endoscopically placed nasoseptal flap for neonatal CSF leak is a viable and useful option for a pediatric skull base surgeon.