The management of post-traumatic cerebrospinal rhinorrheain children creates a challenge for the neurosurgeon. The neurosurgeon must clearly know this because he is the first to be able to track a cerebrospinal rhinorrhea and undertake an assessment leading to diagnosis and treatment. The main objective of this study is to show our experience and the interest of endoscopic surgery and especially the multi-layer technique in the treatment of post-traumatic osteo-dural defects in the roof of the ethmoid bone in the pediatric population.

Thirty-five children, 13 girls/22 boys, mean age 8 years (range from 2–15years) with post-traumatic cerebrospinal rhinorrhea, radiological exploration including multi-planarscanner, MRI with transit isotopic images help determine the exact location of the defect in the roof of the ethmoid bone. The children were operated in 2011–2015 by an endoscopic approach with the multi-layers technique. A long-term follow-up ranges from 12 to 52months (clinical and radiological).

The major symptom is unilateral rhinorrhea in all patients (100%), right in 25 patients (71.5%) and left in 10 children (28, 5%) occurring in a period ranging from 6–24months. Repeated meningitis was observed in 15 children (42.8%) and the notion of impaired consciousness was reported in 5 children (14, 2%). Isolated headache in 10 children (28.5%). Allosteo-dural defects were identified by preoperative radiological protocol. In 4 children (11, 4%), we found a defect associated with small meningoceles without cerebral hernia while in 8 patients (22, 8%), it was ameningo-encephalocele associated with osteo-dural defect more or less wide. The defect is more common on the right than the left (25 right against 10 left). The hospital stay varies between 7 to 10 days after removal of the ball on the fifth day. After a long follow-up of 12–60months, we have reoperated three cases of osteo-dural defects. The results are 100% successful.

Post-traumatic cerebrospinal rhinorrhea in the child is located at the cribriform plate and the roof of the ethmoid, they are treated by endoscopic endonasal approach and closing is done by the multi-layer technique with a nasal septal pedicle flap. This minimally invasive approach avoids the complications associated with transcranial approach. Minimally invasive techniques continue to evolve with low morbidity and a success rate close to 90%.