gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

Frontal sinusotomy in the treatment of fronto-basal cerebrospinal fluid fistulas – less invasive, but likewise effective

Meeting Abstract

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  • Rene Moringlane - Abteilung für Neurochirurgie, Universitätsmedizin Göttingen
  • Lothar Mayfrank - Abteilung für Neurochirurgie, Universitätsklinikum der RWTH Aachen
  • Veit Rohde - Abteilung für Neurochirurgie, Universitätsmedizin Göttingen; Abteilung für Neurochirurgie, Universitätsklinikum der RWTH Aachen

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMO.14.03

doi: 10.3205/15dgnc064, urn:nbn:de:0183-15dgnc0648

Published: June 2, 2015

© 2015 Moringlane et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objective: The common neurosurgical approach for the management of mostly traumatic fronto-basal cerebrospinal fluid (CSF) fistulas is the bifrontal craniotomy. Osteoplastic frontal sinusotomy, rarely performed in neurosurgery, is less invasive, but likewise offers access to frontal skull base, if the dorsal frontal sinus wall is removed. We aimed to investigate if frontal sinusotomy could be successfully used for closure of fronto-basal CSF fistulas.

Method: Covering a 12-year-period in two institutions, we searched the medical files of all patients undergoing frontobasal surgery for CSF fistula and/or dura lesion and then identified those patients in whom frontal sinusotomy and dura closure was performed.

Results: Overall, 57 patients were identified. CSF leakage etiology were trauma (n=51), tumor invading the anterior skull base (n=2), encephalocele (n=1), spontaneous rhinoliquorrhea (n=1) frontobasal abscess (n=1). Five non-fetal complications without long-term sequelae (9 %) occurred, of whom 1 hygroma and 1 recurrent frontobasal abscess required second surgery. The mortality rate was 1.8 % (circulatory arrest, not related to surgery). In 2 patients with a fracture line in the sphenoid sinus, planned second transnasal surgery was performed. Only one patient (1.8 %) required a second operation because of persisting CSF fistula.

Conclusions: This is the largest series of CSF fistulas treated via frontal sinusotomy. Frontal sinusotomy is less invasive than the common bifrontal approach, but is nonetheless highly effective in successfully obliterating a CSF fistula. In our institution, frontal sinusotomy is the preferred approach for the closure of frontobasal CSF fistulas.