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Cerebrospinal fluid rhinorrhoea is the abnormal leakage of cerebrospinal fluid into the nasal cavity. The posterior wall of the frontal sinus can be the site of such leakage. Traditionally, these leaks were repaired via external osteoplastic or neurosurgical approaches. Despite advances in instrumentation, it is difficult to manage superiorly or laterally placed defects endoscopically. We present a new technique of endoscopic repair of frontal sinus posterior wall defects, via access holes drilled in the anterior wall of the frontal sinus.
Preliminary study involving patients presenting with frontal sinus cerebrospinal fluid leaks, with defects in the frontal sinus posterior wall, between 2006 and 2010.
Patients were treated in a tertiary referral centre for nose and sinus diseases. Patient records were reviewed and analysed.
Nine patients underwent external frontal sinusotomy under endoscopic vision. Repair was successful in all cases, with no complications. Follow up ranged from three months to three years.
External frontal sinusotomy and endoscopic repair is a simple, precise and cosmetically acceptable alternative to osteoplastic and major neurosurgical techniques for management of frontal sinus posterior wall defects. This new, previously undescribed technique enables otolaryngologists to play a role in managing such defects.
To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.
Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.
Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.
A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.
Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.
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