The subcranial approach for the management of cerebrospinal rhinorrhea

Because of the likelihood of intracranial complications, optimal treatment for cerebrospinal fluid (CSF) fistula is to have the leak closed. We elected to use the extended subcranial approach in a group of 11 patients with CSF rhinorrhea. Selection criteria included large defects of the anterior skull base (>15 mm), defects not accessible by endoscopes, fistula sites that could not be localized preoperatively, and multiple and transverse fractures of the cribriform area. Resolution of rhinorrhea was achieved in all patients. Anosmia was the only postoperative complication. The indication for this approach, the surgical technique, and various aspects concerning reconstruction are highlighted.