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 complications, optimal treatment for a cerebrospinal fluid (CSF) fistula is to close the leak. The neurosurgical approach to the management of CSF rhinorrhea has been by intracranial access. Extracranial approaches are now gaining 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 patients with CSF rhinorrhea. Selection criteria included defects of the anterior skull base greater than 15 mm in diameter, defects not accessible by endoscopes, fistula sites that could not be localized preoperatively, and multiple and transverse fractures of the cribriform region. Follow-up ranged from 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 the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of CSF rhinorrhea involving the anterior skull base.