doiSerbia

Association of post-traumatic communication of endocranium and nasal cavity with recurrent meningoencephalitis without rhinorrhea

Đilvesi Đula (Neurohirurška klinika, Klinički centar Vojvodine, Novi Sad)
Vuleković Petar (Neurohirurška klinika, Klinički centar Vojvodine, Novi Sad)
Cigić Tomislav (Neurohirurška klinika, Klinički centar Vojvodine, Novi Sad)
Kojadinović Željko (Neurohirurška klinika, Klinički centar Vojvodine, Novi Sad)
Papić Vladimir (Neurohirurška klinika, Klinički centar Vojvodine, Novi Sad)
Horvat Igor (Neurohirurška klinika, Klinički centar Vojvodine, Novi Sad)

Introduction. A gunshot head injury, characterized by a huge intensity of mechanical force, in addition to the direct tissue damage at the location of direct impact, may cause a skull and skull base fracture, distant from the the point of direct impact, which could be further complicated by creating a communication between endocranium and nasal/paranasal cavities. Such cases pose a great diagnostic and therapeutic challenge for every clinician. Case report. The patient is presented with the history of a perforating gunshot head injury six years ago, with recurrent attacks of meningoencephalitis subsequently, without rhinorrhea. By using high resolution CT scans, previous traumatic skull injury was verified and a fissure in the frontoethmoidal region, far from the point of direct impact, was detected. The patient underwent transnasal endoscopic surgery, in order to seal the communication on skull basis. The patient did not suffer from meningoencephalitis during the next two years. Conclusion. In the cases with late occurrence of posttraumatic meningoencephalitis with no signs of rhinorrhea, a possibility of an existing communication between intracranial and nasal cavities should be considered, as well. By applying modern diagnostic and therapeutic procedures such communication should be precisely located and sealed.

Keywords: head injuries, penetrating, fistula, cerebrospinal fluid rhinorrhea, meningitis