[The fronto-supra-ethmoidal approach. Its value in cerebrospinal rhinorrhea].

A supra-ethmoidal approach was used to treat cerebrospinal fluid rhinorrhea secondary to anterior fractures of the base of the skull. After an internal orbital incision, the anterior wall of the frontal sinus is removed and the posterior wall of this sinus trephined in the internal region of its horizontal portion in order to expose the meninges covering the roof of the first ethmoidal space. Dissection is continued within the space towards the anterior extremity of the apophysis of the crista galli against which the fibrous band issuing from the anterior ethmoidal opening is sectioned. The dura mater is then separated from the cribriform plate of the ethmoid up to the jugum sphenoidale posteriorly, while progressively coagulating and sectioning the nerve and connective tissue network attached to the cribriform plate. This freeing of the dura mater exposes the meningeal fistula and allows its liberation from its bony adhesions. A fragment of epicranium removed from the frontal bone is spread between the dura mater and the cribriform plate in order to cover it completely. A drain is then introduced into the nasofrontal canal and the anterior wall of the frontal sinus replaced in position. The advantages of this technique are: the operation is simple, it allows good exposure of the fistula, and since the bony support of the ethmoid is not destroyed the meningeal opening can be easily obstructed.