title: Surgical technique for the prevention of cerebrospinal fluid leakage after bifrontal craniotomy.
abstract: BACKGROUND
  Cerebrospinal fluid leakage and meningitis caused by frontal sinus (FS) exposure are characteristic complications of bifrontal craniotomy used for treating skull base tumors and anterior communicating artery aneurysms. Prevention of these complications is of utmost importance. We describe in detail our procedure for sealing exposed FSs during bifrontal craniotomy and present the results and outcomes of the procedure.
  
  
  METHODS
  A total of 51 consecutive patients who had undergone bifrontal craniotomy for tuberculum sellae meningiomas, craniopharyngiomas, anterior cerebral artery aneurysms, or other frontal skull base lesions at our institute were selected for the study. Our technique for sealing exposed FSs is described below. The mucosa was sterilized using surgical cotton dipped in iodine. After craniotomy, the exposed mucosa was sealed using 7-0 nylon sutures, whereas Gelfoam with fibrin glue was used to ensure watertight closure. The exposed portions of the FSs were covered by bone covers made of internal table bone and sealed. As a final layer, frontal periosteal flaps were sutured to the frontal base dura mater.
  
  
  RESULTS
  Postoperative cerebrospinal fluid leakage or meningitis did not occur in any of our patients.
  
  
  CONCLUSIONS
  Our results indicate the effectiveness of our technique in the prevention of FS-related postoperative complications.
authors: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan. Electronic address: ymurai@nms.ac.jp.
authors: Yasuo
authors: Y
authors: Murai
authors: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors: Takayuki
authors: T
authors: Mizunari
authors: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors: Shiro
authors: S
authors: Kobayashi
authors: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
authors: Akira
authors: A
authors: Teramoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control*; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008581:Meningitis / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D010521:Periosteum / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D055815:Young Adult
keywords: Cerebrospinal fluid; Frontal sinus; Rhinorrhea; Skull base