The subcranial approach for the treatment of cerebrospinal fluid rhinorrhea: A report of 10 cases

Fliss, Dan M.; Zucker, Gideon; Cohen, Jacob T.; Gatot, Albert

doi:10.1053/joms.2001.26720

Cited by 16 publications

(16 citation statements)

References 18 publications

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“…2,7,14,[19][20][21][22][23][24] Teamwork between head and neck surgeons and neurosurgeons using combined craniofacial resections has extended the frontiers of surgery to deal successfully with extensive tumors of the skull base. 14,17,[24][25][26][27][28][29] Quantification of the additional exposure obtained after performing the osteotomies helps objectively assess the advantages of a particular technique. Alaywan and Sindou demonstrated that adding an orbitozygomatic osteotomy to a pterional craniotomy improves the field of view angle by 75% from 11 to 19 degrees.…”

Section: Discussionmentioning

confidence: 99%

Quantification of the Advantages of the Extended Frontal Approach to Skull Base

et al. 2004

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This anatomic study evaluated the extent that a fronto-orbital osteotomy (FOO) added to a bilateral frontal craniotomy widened the exposure to the midline compartment of the anterior, middle, and posterior cranial fossae. The goal was to determine if osteotomy would significantly increase angles for two targets: the foramen magnum (FM) and anterior clinoid process (ACP). Stepwise dissections were performed on five cadaveric heads. A bilateral frontal craniotomy was made, followed by FOO. After the ethmoids were removed, the planum sphenoidale was drilled to enter the sphenoid sinus. Further drilling exposed the anterior clivus, which was drilled down to FM. Excellent exposure of the basilar artery, vertebral artery, and brain stem was achieved. With and without FOO, angles of exposure were measured for two targets: the ACP and FM. The angle of exposure after FOO increased markedly with an average gain of 76% for the ACP and of 80% for FM. Compared with a conventional bifrontal craniotomy, the addition of FOO increased the surgical exposure and minimized frontal lobe retraction for accessing lesions of the anterior, middle, and posterior cranial fossae.KEYWORDS: Brain tumor, extended frontal approach, operative approach, skull base, skull base tumor Large skull base tumors have always been a formidable challenge to neurosurgeons and maxillofacial surgeons. Cushing, Dandy, and others proposed skull base operations, 1 but their enthusiastic attempts were often hampered by the absence of antibiotics and adequate instruments. Technical advances (operating microscopes, micro-instrumentation, bipolar coagulation, and development of neuro-anesthesia); an improved understanding of skull base anatomy 2,3 ; and collaborative efforts of neurosurgeons, otolaryngologists, and plastic surgeons have led to the development of more

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Section: Discussionmentioning

confidence: 99%

Quantification of the Advantages of the Extended Frontal Approach to Skull Base

et al. 2004

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“…32,33 The subcranial approach instead has proved to be a safe and effective method treating complex frontobasal fractures giving an access that is quick to realize and that provides a wide visibility of the anterior skull base. [14][15][16]34,35 It allows to widely expose the posterior wall of the frontal sinus avoiding traumatisms of the cerebral tissue but, as we said before, it should not be performed when sinus is not well represented or when fracture is extended or associated with significant intracranial hematomas.…”

Section: Discussionmentioning

confidence: 99%

Anterior Cranial Fossa Traumas: Clinical Value, Surgical Indications, and Results—A Retrospective Study on a Series of 223 Patients

et al. 2012

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Objective?Frontobasal fractures are relatively common traumas but surgical indications are still discussed. The authors report their results on patients showing anterior cranial fossa fractures; clinical data, surgical indications, and results are reported and critically analyzed. Methods?From 1991 to 2010, 223 patients were admitted in our institution with diagnosis of anterior cranial fossa fracture. Fractures were classified as type A?fracture of the anterior wall of the frontal sinus; type B?fracture of the posterior wall of the frontal sinus; and type C?frontobasal traumas without involvement of the frontal sinus. All patients entered a follow-up program consisting in periodic controls. Results?A total of 105 patients were conservatively treated, while 118 patients underwent surgical intervention. The presence of pneumocephalus (p?

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“…Many authors used different kinds of extracranial−external approaches subsequently for the repair of CSF leaks which were located at the frontal sinus, the ethmoid roof and in the sphenoid sinuses [2,12 ± 14]. Although these approaches cause less morbidity than the intracranial techniques, they have still considerable drawbacks [2,4,5]. Ex− tracranial−external approaches ideally can be used to repair de− fects located at the posterior wall of the frontal sinuses.…”

Section: Discussionmentioning

confidence: 99%

“…Extracranial−external approaches for the repair of CSF leaks do not have the risk of craniotomy. However, higher rates of postoperative anosmia, facial scars, limited visibility and access to the dura at the lateral extent of the orbital roof, parasellar and clival regions are the still continuing disadvanta− ges of extracranial approaches [5]. Relatively higher rates of re− currence of CSF leak after intracranial closure may be associated with complicated CSF fistula accompanied with extensive com− minuted fractures of the anterior cranial base, infected field and additional brain injury as a result of severe trauma [2].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Different Surgical Approaches for the Treatment of Cerebrospinal Fluid Rhinorrhea

Tosun¹,

Gönül²,

Yetışer³

et al. 2005

Minim Invasive Neurosurg

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The current treatment method for cerebrospinal fluid (CSF) rhinorrhea is surgical repair of the fistula. The aim of this study was to analyse different surgical approaches used for the treatment of CSF rhinorrhea regarding several preoperative and postoperative variables to determine the optimal method in these patients. Patients' charts were retrospectively reviewed to get the required data. Twenty-six patients who underwent different types of surgical approach for the treatment of CSF rhinorrhea were included in the study. Patients who had extensive comminuted fractures of the anterior cranial base and additional brain injury besides CSF rhinorrhea, mostly as a result of gunshot injuries, underwent craniotomy (n = 14). Osteoplastic frontal sinusotomy was used in two patients with a dural defect located at the posterior wall of the frontal sinus. Uncomplicated CSF fistulas in ten patients, located at the anterior and posterior ethmoid roof and in the sphenoid sinus, were closed with an endonasal endoscopic approach. Postoperative success rate was higher (97 % for intracranial approach, 100 % for extracranial external and endonasal endoscopic approach) for all techniques. Anosmia was the most frequent permanent complication (n = 5), seen after craniotomy. In conclusion, endonasal endoscopic approach can be preferred for the closure of uncomplicated CSF fistula, located at the anterior or posterior ethmoid roof and in the sphenoid sinus, due to its minimal postoperative morbidity. Uncomplicated CSF fistula, located at the posterior wall of frontal sinuses can be repaired extradurally with osteoplastic frontal sinusotomy. Intracranial approaches should be reserved for more complicated CSF rhinorrhea which results from extensive comminuted fractures of the anterior cranial base and is accompanied with intracranial complications.

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The subcranial approach for the treatment of cerebrospinal fluid rhinorrhea: A report of 10 cases

Cited by 16 publications

References 18 publications

Quantification of the Advantages of the Extended Frontal Approach to Skull Base

Quantification of the Advantages of the Extended Frontal Approach to Skull Base

Anterior Cranial Fossa Traumas: Clinical Value, Surgical Indications, and Results—A Retrospective Study on a Series of 223 Patients

Analysis of Different Surgical Approaches for the Treatment of Cerebrospinal Fluid Rhinorrhea

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