Comment

It appears that most endoscopic techniques produce a success rate of approximately 90% after one attempt, which compares favorably with the transcranial tech-

Fractured Turbinates
b

Fig. 15.20 a A defect in the anterior skull base after intranasal surgery for polyposis. b Fluorescein and a blue filter, which helped to define the extent of the leak and show that there was

Middle Turbinate

Fig. 15.20 a A defect in the anterior skull base after intranasal surgery for polyposis. b Fluorescein and a blue filter, which helped to define the extent of the leak and show that there was more than one leak. c Brain herniating through the defect and fascia being introduced. d Fascia placed over and under the skull base defect.

Osteoplastic Approach Frontal Sinus

Fig. 15.21 a Extensive pneumocephalus due to a fracture involving the posterior wall of the frontal sinus. b Transfrontal osteoplastic approach to define the defect in the posterior wall of the frontal sinus.

Fig. 15.21 a Extensive pneumocephalus due to a fracture involving the posterior wall of the frontal sinus. b Transfrontal osteoplastic approach to define the defect in the posterior wall of the frontal sinus.

Plating Forehead
Fig. 15.21 c Fascia and fat overlay grafts. Note that the incision was done through a forehead crease in an elderly man. d Plating of the osteoplastic flap.
Osteoplastic Flap

Fig. 15.22 a Coronal CT scan with a defect in the sphenoid sinus (arrow). b Fascia plug into the defect between the optic nerve and carotid artery. c Fascia and fat overlay in the lateral wall of the sphenoid sinus.

niques that have a success rate of approximately 75% (Jones, 2001 b; Simmen et al., 1998). The endoscopic repair of anterior and sphenoid CSF leaks or en-cephaloceles is now the treatment of choice in most of these lesions. A recent meta-analysis (Hegazy et al., 2000) confirms this view. It reduces the significant morbidity and mortality associated with a transcranial

Csf Leak Sphenoid Roof

approach (loss of sense of smell, length of inpatient stay, epilepsy, cerebral edema, frontal lobe dysfunction, osteomyelitis of the frontal bone flap and rarely, but importantly, postoperative intracranial hemorrhage). An extradural approach is often needed for defects of the posterior wall of the frontal sinus as these may not be accessible endoscopically. Defects larger

Tlr And Lupid Raft

than 5 cm cannot readily be managed endoscopically (Fig. 15.23 a-c). If there is an associated malignancy or an extensive cosmetic deformity, then craniofacial surgery needs to be done in conjunction with repair of a leak. The majority of other CSF leaks are highly amenable to an endoscopic repair.

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