Endoscopic Repair of CSF Leaks in the Postero-Superior Wall of the Frontal Sinus – Report of 2 Cases

Abstract

Bony defects extending laterally or superiorly within the posterior wall of the frontal sinus are generally deemed too difficult for endoscopic repair in spite of significant progress in surgical endoscopic techniques. We describe a technique of endoscopic repair of posttraumatic cerebrospinal fluid (CSF) leak from the postero-superior aspect of the frontal sinus in a 40- and a 29-year-old male. In both cases after careful assessment of the surgical anatomy the sinus was widely opened transnasally (Draf IIB and Draf III approach, respectively). Angled (45 and 70°) optics and malleable, individually profiled instruments were used to fit specific anatomic variations encountered during the procedure. Endoscopic manipulation near the dome of the sinus proved to be very limited in spite of a wide surgical opening. In our cases the site of the leak could be identified and successfully sealed with gentle pressure on the dura mater. The bony defects were repaired with a 2-layer reconstruction technique. There were no signs of recurrence during 6 months follow-up. With contemporary endoscopic instrumentation, endoscopic closure of CSF leaks in the supero-posterior wall of the frontal sinus is feasible, especially in patients with favourable anatomy of the frontal sinus.