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. 2014 Jun;75(3):183-6.
doi: 10.1055/s-0033-1363503. Epub 2014 Mar 3.

Minimally Invasive Technique for Repairing CSF Leaks Due to Defects of Posterior Table of Frontal Sinus

Kranti Bhavana  1 , Raj Kumar  1 , Amit Keshri  1 , Sushil Aggarwal  1
Affiliations

Minimally Invasive Technique for Repairing CSF Leaks Due to Defects of Posterior Table of Frontal Sinus

Kranti Bhavana et al. J Neurol Surg B Skull Base. 2014 Jun.

Abstract

Objective Cerebrospinal fluid (CSF) leaks from the frontoethmoid and sphenoid region can be easily dealt with endoscopic approaches, but CSF rhinorrhea due to frontal sinus fractures are difficult to treat solely by the nasal endoscopic approach and may require external repair. The technique described targets defects of the posterior table of the frontal sinus where conventional osteoplastic approach of obliteration is usually done. This technique is minimally invasive and involves repair using an endoscope via a frontal trephine. Methods We have treated five cases of traumatic CSF rhinorrhea with this technique, and the mean follow-up is 1 year (range: 10-14 months). The frontal sinus is opened by making a small stab incision (frontal trephine), and the defect site is localized by visualization via endoscope through the trephine. The repair is then performed with fat, bone graft, and fibrin glue. Results Closure of the defect was achieved in a single stage in all the patients, and none of them had a recurrence of leak in the 1-year follow-up period. Conclusion This is a good technique for superiorly and laterally placed posterior table defects of the frontal sinus with minimal morbidity and excellent closure rates.

Keywords: CSF rhinorrhea; endoscopic repair; frontal sinus; frontal trephine; posterior table fracture.

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Figures

Fig. 1
Fig. 1
Coronal computed tomography scan cut showing site of frontal sinus cerebrospinal fluid leak.
Fig. 2
Fig. 2
Axial cut of computed tomography scan showing large defect in the posterior table of the frontal sinus.
Fig. 3
Fig. 3
Coronal computed tomography scan showing pneumocephalus due to frontal sinus cerebrospinal fluid leak.
Fig. 4
Fig. 4
Operative picture of the incision used for frontal trephination.
See this image and copyright information in PMC

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