Delayed appearance of posttraumatic cerebrospinal fluid fistulas as a cause of recurrent meningitis

Immediate post-traumatic fistulas with rhinorrhea are well known after head injury with frontobasal trauma. Less attention is paid to the possibility of delayed onset of rhinorrhea after severe head injury. Unrecognised frontobasal injury may cause recurrent meningitis due to communication of CSF with the outside world. In the last 5 years, seven patients who developed rhinorrhea 2-25 years after trauma were treated in our department. All patients had been through at least two episodes of meningitis. Intermittent rhinorrhea was reported by four. In all cases, coronal bone window CT scan disclosed a bony defect of the anterior skull base, and in three cases an encephalocele was revealed on MRI. Treatment consisted of reconstruction of the anterior skull base with a pedicled galeal-pericranial flap via bifrontal craniotomy. Delayed traumatic CSF fistulas are not rare but must be considered in the differential diagnosis of recurrent meningitis.