Delayed diagnosis and surgical repair of a chronic post-traumatic cerebrospinal fluid fistula with encephalocele in a child.

Background: Encephalocele is a pathological condition characterized by the herniation of intracranial contents through a cranial bone defect. Although most cases are congenital, traumatic encephaloceles can occur following blunt head injury, surgical interventions, or other acquired causes. These lesions are clinically significant due to their association with cerebrospinal fluid (CSF) leakage and the risk of life-threatening meningitis. Traumatic encephaloceles in children are exceedingly rare, particularly those involving the fronto-ethmoidal region. Case Description: We report the case of a 13-year-old girl with delayed-onset CSF rhinorrhea, beginning 4 years after craniofacial trauma. Imaging revealed right frontal and fronto-basal parasagittal cortico-subcortical encephalomalacia, an extensive defect at the ethmoid roof, and an associated ethmoidal encephalocele. The patient underwent single-stage endonasal endoscopic repair with multilayer skull base reconstruction. Postoperative follow-up demonstrated complete resolution of rhinorrhea and no recurrence on imaging. Conclusion: This case highlights the importance of long-term vigilance in pediatric patients with craniofacial trauma and supports the use of endonasal endoscopic techniques as an effective and minimally invasive approach for the repair of chronic CSF fistulas and associated encephaloceles.