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

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 - frontal sinus - posterior table fracture - endoscopic repair - frontal trephine

• References

• 1 May M, Ogura JH, Schramm V. Nasofrontal duct in frontal sinus fractures. Arch Otolaryngol 1970; 92 (6) 534-538
• 2 Gerbino G, Roccia F, Benech A, Caldarelli C. Analysis of 158 frontal sinus fractures: current surgical management and complications. J Craniomaxillofac Surg 2000; 28 (3) 133-139
• 3 Gonty AA, Marciani RD, Adornato DC. Management of frontal sinus fractures: a review of 33 cases. J Oral Maxillofac Surg 1999; 57 (4) 372-379 ; discussion 380–381
• 4 Levine SB, Rowe LD, Keane WM, Atkins Jr JP. Evaluation and treatment of frontal sinus fractures. Otolaryngol Head Neck Surg 1986; 95 (1) 19-22
• 5 Kim KS, Kim HU, Chung IH, Lee JG, Park IY, Yoon JH. Surgical anatomy of the nasofrontal duct: anatomical and computed tomographic analysis. Laryngoscope 2001; 111 (4 Pt 1) 603-608
• 6 Meyer TK, Rhee JS, Smith TL. Frontal sinus fractures. In: Kountakis SE, , ed. Frontal Sinus Disease. New York, NY: Springer; 2005: 133-143
• 7 Reidel-Schenke H. Ueber die Stimhohlen und ihre Erkrankungen [inaugural dissertation]. Jena, Germany; 1898
• 8 Rohrich RJ, Hollier LH. Management of frontal sinus fractures. Changing concepts. Clin Plast Surg 1992; 19 (1) 219-232
• 9 Bergara AR, Itoiz AO. Present state of the surgical treatment of chronic frontal sinusitis. AMA Arch Otolaryngol 1955; 61 (6) 616-628
• 10 Donald PJ, Bernstein L. Compound frontal sinus injuries with intracranial penetration. Laryngoscope 1978; 88 (2 Pt 1) 225-232
• 11 Strong EB, Buchalter GM, Moulthrop THM. Endoscopic repair of isolated anterior table frontal sinus fractures. Arch Facial Plast Surg 2003; 5 (6) 514-521
• 12 Roehm CE, Brown SM. Unilateral endoscopic approach for repair of frontal sinus cerebrospinal fluid leak. Skull Base 2011; 21 (3) 139-146
• 13 Crozier DL, Hwang PH, Goyal P. The endoscopic-assisted trephination approach for repair of frontal sinus cerebrospinal fluid leaks. Laryngoscope 2013; 123 (2) 321-325