Unilateral Endoscopic Approach for Repair of Frontal Sinus Cerebrospinal Fluid Leaks

Objective: Repairing cerebrospinal fluid (CSF) leak remains one of the most difficult surgeries for the rhinologist. Perhaps the most challenging form is when the frontal sinus is involved. The decision-making process often involves a bicoronal flap, a trephine, an endoscopic unilateral approach, a bilateral endoscopic approach, or a combination of two of these. We describe a series of patients that underwent a successful unilateral endoscopic approach to repair a frontal sinus CSF leak. Materials and Methods: A retrospective review identified four patients over a 1-year period with a CSF leak that involved the frontal sinus. All were approached with a unilateral endoscopic approach for closure. Results: Three patients were closed on the first surgical attempt, and one had a communicating hydrocephalus that required a revision procedure. Free septal grafts were used for repair in two patients and DuraGen was used in the other two. The etiologies for the leak included: a previous craniotomy for a frontal sinus/frontal lobe mucopyocele, a spontaneous meningoencephalocele, erosion due to mucormycosis, and sinus surgery. The frontal sinus has remained patent on office endoscopy in three of the four patients. None of the patients have evidence of a leak at a minimum of 6 months after surgery. Conclusions: The repair of frontal sinus CSF leaks is possible in certain cases with a purely endoscopic unilateral approach. This appears to be possible with various different pathologies. Surgeons should consider this approach when selecting the right procedure for a patient with a frontal sinus CSF leak.