[Subcranial subfrontal approach for the treatment of extensive cerebrospinal fluid leaks].

BACKGROUND AND PURPOSE: Over the time, the management of cerebrospinal fluid (CSF) rhinorrhea has been a major surgical challenge. In this paper, we will describe our experience using the extended anterior subcranial approach for the repair of extensive or previously treated CSF leaks. This approach consists of a nasoorbitofrontal bony flap, then an ethmoidectomy and sphenoidectomy are performed and the empty space is filled with subcutaneous fat, a pediculated periostal flap is dissected and layed extradurally at the base of the anterior cranial fossa.

METHODS

Between January 1994 and December 1999, we reviewed the charts of 7 men and 3 women with a mean age of 36.5 years. The etiology was traumatic in 8 cases. One patient had a spontaneous CSF leak, the other had a macroprolactinoma.

RESULTS

The average duration of surgery was 5 hours. Patients were kept in the Intensive Care unit for an average period of 36 hours. The mean follow-up period was 30 months. The success rate was 100%. Postoperatively, all of our patients were anosmic, four of them had anosmia as a preoperative finding. Cosmetically, the skin incisions are limited to the bicoronal incision.

CONCLUSION

Knowing that the classical subfrontal and endoscopic approaches have their definite indications, our experience with the extended anterior subfrontal approach in the treatment of extensive or multiple anterior fossa defects suggests that it is a reliable procedure, giving an excellent access with low morbidity, provided that the patients are selected properly.