Treatment of recurrent cerebrospinal fluid rhinorrhea with a free vascularized omental flap: A case report

Cerebrospinal fluid fistulas after pericranial surgery are a major source of morbidity. A patient who underwent transsphenoidal sinus surgery for a recurrent pituitary adenoma was presented. The patient developed a chronic CSF leak despite standard management, including subarachnoid CSF drainage and transnasal endoscopic closure of the dura. Successful closure of the CSF fistula was obtained using a free omental flap to the sphenoid sinus. This case is the first reported use of a free microvascularized omental flap in an intracranial position for treating chronic ('SF rhinorrhea. A description of the indications and the surgical technique for free omental closure of CSF fistulas wits provided. The etiology, diagnosis, and management of CSF rhinorrhea are reviewed for the reconstructive surgeon.