Frontal Sinus Cerebrospinal Fluid Leaks: Repair in 15 Patients Using an Endoscopic Surgical Approach

Shi, Jianbo; Chen, Fenghong; Fu, Qing‐Ling; Xu, Rui; Wen, Wang; Hou, Wei; Guo, Jialong; Zhang, Xiangmin; Xu, Geng

doi:10.1159/000275675

Cited by 27 publications

(32 citation statements)

References 23 publications

(30 reference statements)

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“…Management of frontal sinus fractures with CSF leak and significant posterior table displacement has historically been managed with cranialization of the sinus . Surgical techniques have recently evolved to incorporate endoscopic approaches into the treatment algorithm …”

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

“…Because the frontal sinus drainage pathway is kept patent, advantages of the endoscopic approach include preservation of a functional frontal sinus and less reliance on computed tomography (CT) scans for postoperative follow‐up. Shi et al . categorized their series of frontal sinus CSF leaks into 3 groups: (1) type A (9 patients) defects were located in the frontal recess at the posterior wall of the frontal sinus, <1 cm in diameter, and visualized successfully with a transnasal endoscopic approach; (2) type B (4 patients) defects were in the posterior table and partly obscured by a well‐pneumatized agger nasi cell so that a Draf IIa or IIb was required for access; and (3) type C (2 patients) defects were >1 cm in diameter with a small frontal ostium (anteroposterior <6 mm) or located on the posterolateral wall of the frontal sinus and required a combined transnasal and transfrontal endoscopic approach for repair.…”

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

143

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Primary Csf Rhinorrheamentioning

confidence: 99%

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

143

279

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“…[40]. In cases of frontal sinus defects, the modified Lethrop approach is useful either alone or with endoscopic approach [41][42][43].…”

Section: Extracranial Approachesmentioning

confidence: 99%

Journal of ISSN: 2379-6359 JOENTR Otolaryngology-ENT Research Case Report Volume 7 Issue 1 - 2017 Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management

Sumaily¹

2017

JOENTR

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Laboratory a) CSF analysis of the fluid. b) Glucose concentration is >30 mg/dl. Neither sensitive nor specific [10,11].c) Beta-2 transfer in is the gold standard (sensitivity of 94% to 100%, and specificity of 98% to 100%), unfortunately not available in many centers, needs 5-7 days [10]. ImagingThis can be classified into primary and secondary:Primary (helpful in the detection of most of the leaks) [12]:i. MRI cisternography: heavily T2-weighted, fast spin-echo, fatsaturated sequences. Better in prone position with Valsalva maneuver. FLAIR sequence is very useful in differentiating CSF (change to dark) from sinus secretions (persist whitish) without the need for contrast [13,14]. Intrathecal injection of 0.5 ml of gadopentetate dimeglumine, diluted in 3-5 ml of CSF can be added for more details.ii. HRCT: Can show the bony defect and, if there is, any protruding soft tissue through it, and also accumulating fluid, if any. And in some cases pneumocephalus may be seen. It is sensitivity is 88.25 to 93% [15]. It is less sensitive in detecting the exact AbstractCerebrospinal fluid (CSF) rhinorrhea clinical approach and therapeutic techniques are rapidly growing and the literature is almost daily enriched with new studies, techniques, and trials. In this article I tried to collect, summarize and organize the updates on this topic from the English literature, and deliver it in a clinical approach manner with suggested algorithm and clarifying illustration so it can be easily understood by the readers and applied by those who are dealing with such cases. Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management 2/6Copyright: ©2017 Sumaily site of the leak when there are multiple fractures [16].iii. Combination of both HRCT and MRI-cisternography provide higher sensitivity and specificity, but usually it is not cost effective and sometimes its time consuming to wait for both to be ready. So, starting with HRCT is advised [12,13,17]. In)) injection either into the lumbar or suboccipital subdural and nasal pledgets in various highrisk areas. Head scans are acquired 2, 6, 12, and 24 hours. And follow-up scans after 48-or 72-hours. It is useful in the detection of intermittent CSF fluid leaks with sensitivity range of 50 to 100%, and specificity 100%. It is relatively poor in exact localization, therefore it is reserved for complex cases when the diagnosis is in question [24]. d) Nasal endoscopy [25]. The last choice is to explore the nasal cavity and paranasal sinuses via and endoscopic sinus surgery looking for the leak and the defect site. Valsalva maneuver and jugular compression could improve detection rate ( Figure 2). i. Extensive bone defects in the cranial base. Secondaryii. Multiple fractures of the ethmoid bone and the posterior wall of the frontal sinus.iii. Associated intracranial lesions requiring surgery.CSF leak is severe, recurrent, or not amenable to the endoscopic treatment.i. Procedure: up to date, no studies on the types of craniotomy and which type is preferred [31]. For a frontoba...

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“…19,89 Defects of the posterior wall can often be reached and treated using a Draf IIa or III approach. [90][91][92][93] Extranasal approaches are used if the CSF leak site cannot be exposed endonasally or if an extranasal approach is chosen for treatment of other fractures. 20 Small traumatic dural lesions can be closed with a success rate of 90% for the primary surgery and 97% including one revision surgery.…”

Section: Frontal Sinus Fracturesmentioning

confidence: 99%

Frontobasal Fractures

2015

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Frontobasal fractures occur in up to 24% of head injuries and often require a multidisciplinary approach. Besides the common bone fractures, the complex anatomy can cause damage to the sense of vision and smell. Further possibly lethal complications such as cerebrospinal fluid leak followed by meningitis or internal carotid bleeding can follow. Diagnostic and treatment options are reviewed with a focus on the endoscopic endonasal approach.

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Frontal Sinus Cerebrospinal Fluid Leaks: Repair in 15 Patients Using an Endoscopic Surgical Approach

Cited by 27 publications

References 23 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Journal of ISSN: 2379-6359 JOENTR Otolaryngology-ENT Research Case Report Volume 7 Issue 1 - 2017 Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management

Frontobasal Fractures

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