Management of Large Dural Defect with CSF Leak in Hypertelorism Correction

THE RATIONALE: Dural tear is a serious complication during hypertelorism corrective surgeries. Identifying the tear and managing requires considerable expertise. Managing large dural tears correctly is necessary to prevent cerebrospinal fluid (CSF)-related complications in craniofacial surgery. PATIENT CONCERNS: The patient presented with hypertelorism as a part of the Tessier Cleft 0 and sought to correct the widely placed eyes. DIAGNOSIS: Large critical-sized dural tear during modified box osteotomy surgery. TREATMENT: Besides successful modified box osteotomy surgery, the critical-sized dural tear was managed with fascia lata and fibrin glue. OUTCOMES: There was no CSF leak or related complication postsurgically indicating successful sealing and healing of the dural tear. TAKE-AWAY LESSONS: The synergistic mechanism by which fascia lata graft and fibrin glue help to hermetically seal the critical-sized defect, especially when there are variable amounts of hydrostatic-hydrodynamic forces of CSF exerting pressure on the patched area, is discussed.