Meningitis and hydrocephalus secondary to panfacial fracture repair in a traumatic brain injury patient.

The management of post-traumatic cerebrospinal fluid (CSF) leak in the context of facial bone fracture remains a surgical challenge. The complexity increases in those cases of concurrent traumatic brain injury and craniofacial fractures. The optimal timing for facial bone fracture repair is still controversial in traumatic CSF leak patients [1]. An unrestrained, non-helmeted 14-year-old female on a motor scooter sustained injuries when struck by an automobile. She had an initial loss of consciousness,withmultiple contusions and lacerations over the face, trunk and lower limbs. She was subsequently sent to the emergency room of a regional hospital with a Glasgow coma scale of E2V4M5. Brain computed tomography revealed type II frontobasal fracture, Le Fort I maxillary fracture, nasoorbitoethmoid fracture and intracerebral hemorrhage with pneumocephalus (Fig. 1). Shewas admitted to the intensive care unit for further evaluation and management. CSF leak ceased spontaneously 10 days later under conservative treatment. Her general condition improved gradually. The patient was referred to our hospital on the third week for further facial fracture repair. Open reduction and internal fixation of the right zygoma, disimpaction of the bilateral maxilla, orbital floor repair, and closed reduction of nasal bone were carried out on the 25th day after injury. The operation proceeded uneventfully. Prophylactic antibiotic was administered perioperatively, but 35 hours after the operation, fever, chills, vomiting and severe headache were noted. Physical examination revealed a positive Kernig’s and Brudzinski’s signs, raising suspicion for meningitis. Brain computed tomography revealed enlarged ventricles but showed no intracranial hemorrhage. Lumbar puncture