Fracture of the Floor of the Anterior Cranial Fossa and the Sella Turcica, and Successful Repair of the Cerebrospinal Fluid Fistula with Fibrin Glue

Abstract

A case of fracture of the floor of the anterior cranial fossa and the sella turcica, followed by cerebrospinal fluid (CSF) rhinorrhea, which was successfully repaired with fibrin glue, is reported. A 30-year-old male was admitted with Glasgow Coma Scale score 10 after a car accident. Neurological examination disclosed conjugate deviation to the right, with isocoria and prompt light reaction of both pupils. Plain craniograms showed compound and depressed fractures of the frontal bone, an obscurity of the outline of the sella turcica, and pneumocephalus. Computed tomography (CT) scan showed the skull fractures, frontal lobe contusion, subarachnoid hemorrhage and pneumocephalus. An emergency operation was performed to remove bone fragments and contu-sional hematoma, and to repair the dural tear. The patient regained consciousness but showed bitemporal hemianopsia and a decreased visual acuity of both eyes, and developed transient diabetes insipidus and anterior hypopituitarism. Two months later, he developed CSF rhinorrhea, and CT scan disclosed a wide-open fracture of the planum sphenoidale. A second operation was successfully performed to repair the CSF fistula, using fibrin glue as a sealing material for the bone defect in the sphenoid sinus. Dura was also repaired this time. Fibrin glue seems to be a very useful and logical material for the treatment of CSF leakage. Fracture of the sella turcica is rather uncommon, but should be searched for if cranial nerve injuries, CSF leakage, diabetes insipidus or hypopituitarism are found. © 1986, The Japan Neurosurgical Society. All rights reserved.