36 - Transorbital and transfrontal approaches to cerebrospinal fluid leak repair

Abstract

Transorbital endoscopic techniques allow excellent surgical access, providing complementary approaches to transnasal portals that overcome some of the limitations of transnasal endoscopic procedures. These procedures are highly effective when used alone or in multiportal techniques with transnasal and other approaches (e.g., paramaxillary, transcranial) to improve working space, facilitate coplanar surgery, and permit pseudo-parallax viewing of target manipulation with diminished reliance on haptic feedback through wide offset between the endoscope and instrument(s). We found that these approaches allowed access to the entire anterior cranial fossa (ACF), including the interorbital skull base and frontal sinus, as well as significant components of the middle cranial fossa (MCF) for a wide variety of adult and pediatric indications, including resection of benign and malignant tumors and vascular and lymphatic malformations; management of cerebrospinal fluid (CSF) leaks and tension pneumocephalus; repair of trauma of the orbit, frontal sinus, and frontal bone; management of advanced mucoceles of the orbit, frontal sinus, and ACF; orbital and optic nerve decompression; foreign body removal; and drainage of abscesses of the orbit, frontal sinus, and brain. This chapter focuses on the use of transorbital endoscopic pathways in the management of ACF CSF leaks.