Purely endoscopic pterional extradural approach: A novel technique for repair of cerebrospinal fluid rhinorrhea.
METHODS
Retrospective descriptive study of an innovative surgical technique.


OBJECTIVE
To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope.


BACKGROUND
Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches.


METHODS
Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6-18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit.


RESULTS
Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed.


CONCLUSIONS
This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches.
Department of Neurosurgery, Sir Ganga Ram Hospital, New Delhi, India.
Ajit Kumar
AK
Sinha
Department of Neurosurgery, Sir Ganga Ram Hospital, New Delhi, India.
Sumit
S
Goyal
Cerebrospinal fluid rhinorrhea; endoscopic repair; frontal sinus leak; transcranial repair