case_images: PMC10575747_01
case_images: CT images of skull base defects. Red arrows point to skull base defects. (a) Preoperative coronal CT demonstrating defects in left sphenoid sinus and pneumocephalus. (b) Preoperative coronal CT demonstrating defects in left sphenoid sinus. (c) Preoperative coronal CT demonstrating defects in posterior left ethmoid roof. (d) Preoperative coronal CT demonstrating defects in posterior left anterior ethmoid roof. (e) Preoperative sagittal CT demonstrating multiple defects in the roof of the left ethmoid and sphenoid sinuses. (f) Axial CT demonstrating fracture of posterior wall of sphenoid sinus.
case_images: CRIOT2023-6996215.001.jpg
case_images: PMC10575747_01_CRIOT2023-6996215.001.jpg
case_images: fig1
case_images: Intraoperative repair and reconstruction of defects: Tensor fascia lata (TFL) and nasoseptal flap (NSF). (a) Fracture in posterior wall of left sphenoid sinus. (b) Fat in posterior sphenoid sinus wall defect. (c) TFL graft. (d) NSF placed onto TFL graft. (e) Surgicel being placed onto edges of NSF. (f) Dural sealant being sprayed onto NSF.
case_images: CRIOT2023-6996215.002.jpg
case_images: PMC10575747_01_CRIOT2023-6996215.002.jpg
case_images: fig2
case_images: CSF leak (Figure 2(a)) was found extending from the posterior wall of the left sphenoid sinus to the ethmoid roof and left lateral lamella of the cribriform plate, with transection of both the left anterior and posterior ethmoid arteries and exposure of the cavernous sinus in the posterior wall of the sphenoid sinus. Control of the cavernous sinus bleeding was achieved with the application of SURGIFLO  haemostatic matrix and bipolar diathermy. A posteriorly based left nasoseptal flap was raised and placed into the nasopharynx (Figure 2(d)). TFL, nasoseptal flap, and hydrogel dural sealant (Adherus Autospray ET) (Figures 2(b)-2(f)). The mid-anterior ethmoid and lateral lamella defects were closed again with a 3-layer closure: Fat, TFL, free mucosal graft (from middle turbinate), and hydrogel dural sealant. An absorbable haemostat dressing (Surgicel  (oxidized regenerated cellulose)) was applied around the edges of the nasoseptal flap and free mucosal graft (Figure 2(e)).
case_images: Postoperative coronal CT image demonstrating resolution of pneumocephalus.
case_images: CRIOT2023-6996215.003.jpg
case_images: PMC10575747_01_CRIOT2023-6996215.003.jpg
case_images: fig3
case_images: Postoperative CT imaging showed resolution of pneumocephalus (Figure 3).