CSF leak & basilar skull fracture

[Angie1563]

My father fell from a ladder 4 weeks ago.  He suffered severe and numerous basilar skull fractures.  He has persistent CSF leaking from his nose when he sits up.  An attempt was made to "plug" the fractures with fatty tissue; however, this procedure was not successful.  Since these fractures are large in size, what are other options?  One week ago, he was diagnosed with pseudomonas meningititis.  

[Angie1563]

Thanks so much for your prompt reply.  How risky is the procedure that you are talking about because your response seemed to be consistent with my father's neurosurgeon?  He wanted to avoid this type of surgery because of the risks but I'm not sure what those are.  He is 60 years old and is diabetic.  In addition, he was diagnosed with meningitis one week ago.  He is on antibiotics and appears to be responding well to those, however.  
Thanks, Angie

[Caliber2005]

Hi Angie,
How is your father feeling?
Cerebrospinal fluid leak may occur from the nose, from the external auditory canal, or from a traumatic or operative defect in the skull or spine. The fluid leak is a result of meningeal dural and arachnoid laceration with fistula formation. Blunt trauma is the most common cause.
The treatment of CSF leak is primarily surgical. Precise localization of the site of the CSF fistula by using CT, MRI, and cisternographic diagnostic techniques is critical before surgical intervention is done.
Posttraumatic CSF fistulas persisting beyond 7 days, spontaneous CSF leaks with skull-base defects, increasing pneumocephalus, and meningitis are positive indications for surgical intervention. Extradural endoscopic repair by the otolaryngologist is most helpful in cases needing anterior repair around the cribriform plates.
Open craniotomy with intradural repair is the option left for your father.
The primary goal of surgery is to repair meningeal tears and underlying bone defects.
Patients with CSF rhinorrhea or CSF otorrhea are maintained at bed rest in a semi sitting position (bed end raised by 45 degree).
They should be instructed to avoid sneezing or coughing since these actions increase the intracranial pressure and favor persistence of the CSF leak.
Hope this helps.
Bye.