Cranial base fracture associated with pneumocephalus and cerebrospinal fluid leakage following surgically-assisted rapid maxillary expansion: A case report

Surgically assisted rapid palatal expansion (SARPE) is generally safe, with rare major complications. We report a unique case of a 22-year-old woman with a history of meningomyelocele who developed pneumocephalus and cerebrospinal fluid (CSF) rhinorrhea six days after SARPE with pterygomaxillary disjunction. Imaging revealed a skull base fracture at the roof of the right sphenoid sinus and bilateral ossified pterygospinous ligaments, which may have redirected osteotomy forces to the cranial base. The patient presented with positional headaches and clear nasal discharge, and CSF leakage was confirmed by MRI. She was successfully managed with conservative treatment, including bed rest, head elevation, and antibiotics. This case highlights the importance of recognizing anatomical variations that may predispose patients to skull base injury during SARPE and stresses the need for prompt evaluation of symptoms like rhinorrhea and headache. Early diagnosis and non-surgical management can lead to favorable outcomes, even in the presence of complex skull base fractures.