Endoscopic Anterior Skull Base Surgery
Cerebrospinal fluid (CSF) leak: Extravasation of the fluid normally contained in the ventricles of the brain, the subarachnoid space and the central canal of the spinal cord through a hole in the lining of the brain or spinal cord (meninges). Within the realm of rhinology and endoscopic sinus surgery, CSF leak generally refers to watery, clear nasal drainage coming through a defect of the cranial base and meninges associated with the frontal, ethmoid or sphenoid sinuses. Likewise, a rhinologist-endoscopic sinus surgeon encounters meningoencephaloceles protruding through cranial defects in the frontal, ethmoid and sphenoid sinuses.
Meningoencephalocele: Protrusion of the brain and its lining (meninges) through a hole in the cranium.
Meningocele: Protrusion of the lining of the brain (meninges) and cerebrospinal fluid through a hole in the cranium.
Two decades ago, cerebrospinal fluid (CSF) leaks, meningoencephaloceles and skull base tumors involving the paranasal sinuses or nasal cavity were managed through external (scalp) incisions and craniotomies (opening the skull by removing bone). The introduction of nasal endoscopes and specialized endoscopic sinus instrumentation allows resection or repair of many anterior skull base lesions through the nose. The endoscopic approach affords decreased patient discomfort, shorter hospitalization and, in many cases, increased visualization for the surgeon during the procedure and during post-operative follow-up or surveillance. Treatment of these lesions via an endoscopic approach requires specialized training of the surgeon and operating room staff with respect to designated instruments and computerized surgical navigation. Treatment often requires a team approach, utilizing the skills of a neurosurgeon and rhinologist-sinus surgeon. Additionally, endoscopic resection of skull base malignancies must be carefully considered by a multidisciplinary team (medical oncologist, radiation oncologist, head and neck surgeon, endoscopic skull base surgeon, neurosurgeon).
Endoscopic repair of CSF leak
Endoscopic repair of CSF leak with fascia lata