This report describes a case of spontaneous cerebrospinal fluid leak through a narrow canal-like fistula in the lateral wall of the sphenoid sinus, which was managed through rigid reconstruction. Rigid reconstruction of the skull base was performed by fitting a pile-shaped bone into the fistula like the pile-driving technique.

A patient with internal carotid artery (ICA) rupture due to multiple irradiations underwent revascularization with high-flow bypass under the condition that endovascular treatment could not be performed. It was possible to safely remove necrotic tissues and reconstruct the skull base using trapping of the ruptured ICA.