The Endoscopic Trephination Approach for Repair of Frontal Sinus CSF Leaks

Abstract

Objective: 1) Describe a less invasive technique than craniotomy or frontal sinus obliteration for the management of frontal sinus skull base defects. 2) Be able to assess the long term results of using a combined endoscopic and frontal sinus trephination approach for the management of frontal sinus skull base defects. Method: Review of series of three cases of patients with frontal sinus skull base defects repaired using a combined endoscopic and trephination approach. Results: The technique was used successfully in 2 patients with traumatic frontal sinus skull base defects and one patient with a spontaneous frontal sinus encephalocele. The cases described demonstrate safe and effective use of endoscopic frontal sinus trephination to repair CSF leaks. In all cases, the surgical approach provided excellent exposure of the skull base defect and allowed for a layered repair. In all cases, long term follow-up has revealed excellent cosmesis and functional frontal sinuses with patent outflow tracts. Conclusion: A combined endoscopic and frontal sinus trephination approach is a safe and effective technique in the management of frontal sinus skull base defects. This technique provides excellent exposure of all aspects of the frontal sinus without the need for a craniotomy or frontal sinus obliteration procedure.