gms | German Medical Science

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.