Transorbital Endoscopic Approach for Repair of Frontal Sinus Cerebrospinal Fluid Leaks: A Single-Institutional Experience

Background: Management of frontal sinus cerebrospinal fluid (CSF) leak is challenging because of its complex anatomy. Recently, tranorbital endoscopic approach (TOEA) has been reported as one of minimally invasive surgeries to repair defect in the frontal sinus.

Objective: This study was aimed to describe surgical technique and our experience in TOEA for the frontal sinus leak repair.

Methods: We reviewed patients with CSF leaks from the frontal sinus who were treated with TOEA in our institution during 2016 to 2019. The surgery began with superior eye lid incision ([Fig. 1]). After exposure of superomedial part of the orbit, entry site of the frontal sinus was located medially to supraorbital nerve with neuronavigator guidance ([Fig. 2]). The defect was identified under endoscopic visualization ([Fig. 3]) and was repaired with multilayered reconstruction technique. Clinical data, location and size of the defect, reconstruction material, patency of the frontal sinus, and follow-up were analyzed.

Results: Sixteen patients (21–61 years) were successfully repaired the leaks with a mean follow-up of 11 months. Etiologies were trauma (75%) and iatrogenic (4%). Eleven patients (68.8%) were recurrent cases from previous surgical repair by either endoscopic endonasal or conventional transcranial approaches. All patients had the defects located in superior or lateral part of the frontal sinus with defect size ranging 2.0 to 30.8 mm in diameter. Drainage of the frontal sinus was preserved in 10 cases (62.5%; [Fig. 4]). There were no complications in this clinical series.

Conclusion: This clinical series revealed that the use of TOEA for the frontal CSF leak repair was effective and can be applied as an alternative minimally invasive technique for management this condition.

Fig. 1 Superior eye lid incision and instrument handling in tranorbital endoscopic approach.

Fig. 2 Entry site of frontal sinus.

Fig. 3 Defect and encephalocele in right frontal sinus was identified under endoscopic visualization.

Fig. 4 Pre-operative CT scan (A) demonstrated defect in posterior wall of right frontal sinus with encephalocele which was repaired by transorbital endoscopic approach. At 6 months, there was no evidence of CSF leak. The defect was completely reconstructed with patency of the frontal sinus shown in the follow-up CT scan (B).

No conflict of interest has been declared by the author(s).