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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 136-140
DOI: 10.4103/ajns.AJNS_363_20
Case Report

A novel combined transorbital transnasal endoscopic approach for reconstruction of posttraumatic complex anterior cranial fossa defect

Ashwin Vedhapoodi
Department of ENT, Government Stanley Medical College, Chennai, Tamil Nadu
,
Anbazhagan Periyasamy
1   Department of Neurosurgery, Madras Medical College, Chennai, Tamil Nadu
,
Devanand Senthilkumar
1   Department of Neurosurgery, Madras Medical College, Chennai, Tamil Nadu
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The transorbital neuroendoscopic surgery (TONES), endoscopic transnasal skull base procedures, and the concept of multiportal minimal access neurosurgery are novel, rapidly evolving approaches in the management of complex skull base lesions. A 27-year-old male presented with a history of road traffic accident with nasal bleed, cerebrospinal fluid (CSF) rhinorrhea, and left eye deformity. There was left upper eyelid ecchymosis, orbital dystopia, left pupil was dilated, and fixed with no extraocular movements. The computed tomography scan showed basifrontal contusion and complex comminuted anterior cranial fossa (ACF) fracture involving left cribriform plate and left orbital roof with fracture fragment impinging on the superior rectus muscle with suspicious orbital CSF leak. There was no improvement with conservative management. Hence, a novel combined TONES, transnasal endoscopic multiportal surgery was undertaken for the removal of fracture fragments and multi-layered closure of the complex ACF defect. The patient had a complete resolution of orbital dystopia and visual loss with no evidence of CSF leak postoperatively.

Key-words:

Anterior cranial fossa fracture - cerebrospinal fluid rhinorrhea repair - combined endoscopic transorbital transnasal approach - orbital cerebrospinal fluid leak - orbital trauma - transorbital neuroendoscopic surgery

Financial support and sponsorship

Nil.




Publication History

Received: 25 July 2020

Accepted: 11 January 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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