Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

Jahanshahi, Javaneh; Zeinalizadeh, Mehdi; Mohammadi, Hasan Reza; Sadrehosseini, Seyed Mousa

doi:10.2500/ajra.2017.31.4478

Cited by 21 publications

(25 citation statements)

References 13 publications

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“…In agreement with the current study, Jahanshahi et al [ 11 ] stated in their retrospective review that the most common etiology was trauma (18 of 24 patients), followed by spontaneous leaks (6/24) and without accounting for the defects caused by excision of the tumor. Gâta et al [ 6 ], with 77.2% of CSF leaks caused by trauma and the rest being spontaneous, had similar findings to us.…”

Section: Discussionsupporting

confidence: 92%

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak

Ismaiel

Abdelazim

Younes

et al. 2021

Annals of Medicine and Surgery

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Introduction and Objectives: Leakage of cerebrospinal fluid (CSF) from the frontal sinus is a challenging condition facing the ENT surgeon. Repair of this condition has been changed nowadays due to the newer instruments and techniques of nasal endoscopy. This study aims to evaluate the outcome of frontal sinus CSF leak endoscopic repair. Patients and methods Twenty-seven patients who had frontal sinus CSF leaks were included in this study. They were 9 females and 18 males. They underwent endoscopic repair of the leak site at the period of five years from 2015 to 2020. A retrospective evaluation of these patients includes reconstructive procedures, complications, and postoperative follow-up. Results The frontal leaks were present in the frontal recess (8 patients, 29.6%), ethmoidal roof (5 patients, 18.5%), and the majority was in the posterior wall (14 patients, 51.9%); 11 in the medial side and 3 in the lateral side. All cases, 27 (100%) were treated successfully, no failed treatment was observed. Postoperative complications were minimal; two patients had elevated intracranial pressure (ICP), infection with fever were found in four patients (7.4%), and meningitis was observed in only two cases (7.4%), treated conservatively. Conclusion For frontal sinus CSF leak repair, the endonasal endoscopic approach is the treatment of choice due to higher success rates and lower morbidity profile. A favorable result is possible with proper diagnosis, precise localization, and an appropriate strategy.

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Section: Discussionsupporting

confidence: 92%

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak

Ismaiel

Abdelazim

Younes

et al. 2021

Annals of Medicine and Surgery

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“…15,23,24 Moreover, a broad view of bilateral frontal sinuses is amenable to a modified Lothrop (Draft III) procedure and one may be better able to instrument in zone 1 and 2 (zone 3 in some cases) bilaterally, through the endonasal corridor. 2,4,8,25 Karligkiotis et al, 26 described the advanced technique of endoscopic endonasal approach using orbital transposition to reach the lateral aspect of the frontal sinus; however, the feasibility of this technique is determined by both the anatomy of the frontal recess and the interorbital distance. In the case of technical difficulty in endonasal route, a multiportal approach "from above and below" should be considered.…”

Section: Discussionmentioning

confidence: 99%

Transorbital Endoscopic Approach for Repair of Frontal Sinus Cerebrospinal Fluid Leaks: Case‐Series

et al. 2020

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Objectives: To highlight the feasibility and evaluate the outcomes of the transorbital endoscopic approach (TOEA) in the management of frontal sinus cerebrospinal fluid (CSF) leaks.Study design: Retrospective case series. Methods: The database of patients with frontal sinus CSF leaks managed with TOEA from January 2017 through December 2019 at our institution was reviewed. Two videos of clinical case examples are presented.Results: Sixteen patients (10 males, 6 females, mean age 53; range 21-61 years) underwent TOEA through the superior eyelid corridor for the repair of frontal sinus CSF leak. The most common etiology of the CSF leak was trauma (nine cases; 56.3%), followed by injury from iatrogenic causes in six cases (37.5%), and spontaneous leak in one case (6.2%). Average defect size was 8.8 mm (range 2.0-20.8 mm). Ten patients were revision cases who had undergone prior nontransorbital CSF leak repair at outside institutions. All patients underwent successful repair via TOEA without postoperative complications. Complete resolution was maintained in all cases. Mean follow-up period was 11 months (range 6-22 months).Conclusions: TOEA is a safe minimally disruptive alternative for definitive management of frontal sinus CSF leak in wellselected primary or revision cases. Further studies are necessary to define its indications and outcomes.

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“…In the endoscopic era of skull base reconstruction, surgical techniques have featured layers of reconstruction with autologous fascia and mucosa and various dural replacement products that are placed in both underlay and overlay fashion along the defect sites. 8,9 The different techniques, indeed, offer good results when a watertight closure between the intracranial and sinonasal cavities is accomplished; however, an adequate seal along the skull base may be difficult to achieve when defects are characterized by irregular edges and shapes. Likewise, gaping defects may be difficult to close with relatively thin layers of autologous and synthetic grafting materials.…”

Section: Discussionmentioning

confidence: 99%

Use of Autologous Fat Grafts for the Endoscopic Reconstruction of Skull Base Defects: Indications, Outcomes, and Complications

Lam

Luong

Yao

et al. 2018

Am J Rhinol�Allergy

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Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods. Four representative clinical cases have additionally been selected to highlight the common indications for which the fat graft may be effective in skull base reconstruction. Results Of the 27 patients who were identified for inclusion in this review, 25 (92.6%) demonstrated successful repair of preoperative or intraoperative CSF leaks following primary skull base repair. Two patients developed recurrent CSF leaks occurring about 1 week after their primary closures, and a secondary closure rate of 96.3% was achieved with use of fat grafts. Other complications included seroma and hematoma formation at the abdominal donor sites, each occurring in 1 patient. Conclusions The use of autologous fat remains a viable option for grafting material during endoscopic skull base reconstruction. Despite the wide variety of closure techniques in skull base surgery, autologous fat provides safe and easily accessible material to repair CSF leaks.

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Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

Abstract: Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

Cited by 21 publications

References 13 publications

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak

Transorbital Endoscopic Approach for Repair of Frontal Sinus Cerebrospinal Fluid Leaks: Case‐Series

Use of Autologous Fat Grafts for the Endoscopic Reconstruction of Skull Base Defects: Indications, Outcomes, and Complications

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