title: Supraorbital Keyhole Approach to the Skull Base: Evaluation of Complications Related to CSF Fistulas and Opened Frontal Sinus.
abstract: OBJECTIVE
  Cerebrospinal fluid (CSF) rhinorrhea due to a breach in the frontal sinus (FS) presents one of the main postoperative complications of the supraorbital keyhole approach. The goal of this study was to further analyze the actual surgical morbidity and potential risk for patients due to an opened FS after a surgery via a supraorbital craniotomy and compare the results with data published in the current literature.
  
  
  METHODS
  A total of 350 consecutive patients who underwent surgeries via the supraorbital keyhole approach for various lesions were included in this retrospective study. Information on clinical history, neurologic symptoms, surgical approach, and postoperative complications was obtained retrospectively by a review of the patients' charts, the radiologic reports, and a thorough review of pre- and postoperative cranial computed tomography (CCT) imaging.
  
  
  RESULTS
  The frequency of CSF rhinorrhea after this type of craniotomy in the literature is reported to range between 0% and 9.1%. In this study, analysis of postoperative CCT scans revealed that 88 patients (25.1%) showed a radiographic breach of the FS. Only 8 of these patients (2.3%) developed a CSF leak with rhinorrhea postoperatively. In all cases conservative treatment with lumbar drainage failed, and therefore a surgical revision for permanent closure was required. Only one patient (0.3%) with a CSF leak also developed meningitis.
  
  
  CONCLUSIONS
  Inadvertent opening of the FS during the supraorbital craniotomy is a common surgery-related morbidity; however, the risk for the patient to develop a potentially dangerous meningitis was found to be minimal.
authors.affiliation: Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Firas
authors.initials: F
authors.lastname: Thaher
authors.affiliation: Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Hopf
authors.affiliation: Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Anne-Katrin
authors.initials: AK
authors.lastname: Hickmann
authors.affiliation: Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kurucz
authors.affiliation: Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bittl
authors.affiliation: Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Henkes
authors.affiliation: Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Guenther
authors.initials: G
authors.lastname: Feigl
mesh_terms: D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D005626:Frontal Sinus / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*