The surgeons had removed the tumor three years prior and sealed the hole in the patient’s skull. Following initial surgery, however, dead tissue caused by radiation therapy reopened the hole, which allowed air to build up and cerebrospinal fluid to leak into the patient’s nose.
To solve the problem, the surgeons took a paramedian forehead flap, an old plastic surgery procedure that cuts a section of skin and muscle from the forehead and rotates it downward. Rather than using the flap to reconstruct part of the nose, which is more traditional, the surgeons put the flap inside the patient’s head through an incision above his nose and then attached it to the skull base to close the hole.
“Saving this patient required something that, to the best of our knowledge, had never been done before,” said Amishav Bresler, MD, one of the report’s authors. The patient has recovered with no recurring cerebrospinal fluid leak.
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