Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: Technical case report - In reply

Our primary purpose in the presented technique of plasty was not to obtain a viable graft. We considered that 1) the CSF leakage was so remarkable that a bilateral subdural hematoma was induced. This required a sealing method able to promptly establish a satisfactory mechanical obstruction, like the inflated pouch described in our article. The amount of rhinoliquorrhea also advised us against using a previously published technique for transmucosal closure of sphenoidal CSF fistulae: we considered this method especially suitable for leaks after transsphenoidal surgery for pituitary adenomas despite an accurate intraoperative plasty; 2) in our opinion, once a prolonged arrest of CSF leakage is obtained, the mechanisms of spontaneous fibrosis should contribute to consolidate the sealant apparatus. This probably happened in our patient, because the favorable result is still lasting (after 3 yr of follow-up).