Case Report: CSF Leak Developed after Adenoidectomy

A 7-year-old girl underwent a tonsillectomy/adenoidectomy operation after which she started having episodes of meningitis. A CSF leak was suspected, and investigations revealed what appeared to be arachnoid granulations in her right petrous apex region. Over the next 30 years, she had multiple external approaches to the area with unsatisfactory results as she continued to develop meningitis, leading to her having an in situ port-a-cath to self-administer antibiotics. The patient, in all this time, when asked could never identify any signs of clear rhinorrhea or other classic signs of CSF leak in the nose. Routine radio imaging investigation in 2011 showed a clearly visible bony defect of the medial wall of her right pterygopalatine fossa anterior to the choana, an area clearly associated with her first operation at the age of 7. An intranasal endoscopic approach to the area was performed. The operation revealed a meningoencephalocele, and a repair was performed with the use of a pedicled septal mucosal flap. Postoperative recovery was uneventful, and the patient has not had an episode of meningitis since. We believe that it is a possibility that the patient had a congenital bony defect of the medial wall of the right pterygopalatine fossa. Some overzealous curettage during her adenoidectomy operation further exposed the defect, creating an iatrogenic CSF leak.