The subcranial approach for the treatment of cerebrospinal fluid rhinorrhea: A report of 10 cases

Purpose: Because of the likelihood of meningitis and other intracranial com plications, optimal treatment for a cerebrospinal fluid (CSF) fistula is to close the leak. The neurosurgical approach to the management of CSF rhinor rhea has been by intracranial access. Extracranial approaches are now gaini ng acceptance as the preferred method for initial treatment of CSF leakage, because the success rates are reasonable, and the morbidity is lower. This report describes the results of using such an approach. Patients and Methods: The extended subcranial approach was used in 10 patie nts with CSF rhinorrhea. Selection criteria included defects of the anterio r skull base greater than 15 mm. in diameter, defects not accessible by end oscopes, fistula sites that could not be localized preoperatively, and mult iple and transverse fractures of the cribriform region. Follow-up ranged fr om 8 to 23 months, with a mean of 17 months. Results: Resolution of rhinorrhea was achieved in 9 (90%) of the patients. Anosmia was the only postoperative complication, occurring in 8 patients. Conclusion: The authors conclude that the extended subcranial approach to t he anterior skull base is a safe, versatile, and effective procedure for th e surgical treatment of CSF rhinorrhea involving the anterior skull base. ( C) 2001 American Association of Oral and Maxillofacial Surgeons.