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Endonasal endoscopic management of frontal sinus cerebrospinal fluid leak
Javaneh Jahanshahi1, Mehdi Zeinalizadeh, Hasan Reza Mohammadi
1Department of Otolaryngology Head and Neck Surgery, Hamadan University of Medical Sciences, Hamadan, Iran.
Background:
A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome.
Objective:
To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach.
Methods:
Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated.
Results:
Among >100 cases of surgically repaired CSF rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Free autografts as two-layer inlay fat-muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients.
Conclusion:
Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.
