Transorbital Endoscopic Repair a Feasible Approach for Select Patients with Frontal Sinus Cerebrospinal Fluid Leaks

by Linda Kossoff •

How feasible is the transorbital endoscopic approach (TOEA) in the management of frontal sinus cerebrospinal fluid (CSF) leaks, and how successful are the outcomes of this approach?

BOTTOM LINE

TOEA is a safe, minimally disruptive alternative for definitive management of frontal sinus CSF leak in well-selected primary or revision cases.

BACKGROUND: Most traumatic frontal sinus CSF fistulae are first managed conservatively, but failure to resolve the leak requires surgical repair that was traditionally limited to open transcranial approaches. More recently, minimally invasive endonasal techniques have been increasingly employed to successfully manage sinonasal CSF leaks. This approach, however, can be technically challenging.

STUDY DESIGN: Retrospective case series.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Missouri, Columbia, Mo.

SYNOPSIS: Researchers identified 16 patients (10 men, 6 women, mean age 53 years) with a history of frontal sinus CSF leaks who received TOEA at a single institution from January 2017 to December 2019. The most common etiology of the CSF leak was trauma (56.3%), followed by iatrogenic causes (37.5%) and spontaneous leak (6.2%). Of the 16 cases, 10 were patients with recurrent CSF leaks who had previously undergone failed surgical repair via transcranial or endonasal procedures at outside institutions. The average defect size was 8.8 mm. In all 16 cases, successful repair was achieved, and front sinus outflow was preserved in 10 cases. Mean follow-up was 11 months, during which time there were no recurrences or postoperative disturbances. Despite these findings, authors enumerate both the advantages of and the limitations to TOEA in terms of visual and instrumental frontal sinus access, depending on the location of the defect. They concluded that transorbital endoscopic repair is a feasible and valuable surgical alternative for frontal sinus CSF leak management in selected patients. Limitations included the small sample size, short-term follow-up, and lack of comparison between TOEA and standard techniques.

CITATION: Noiphithak R, Yanez-Siller JC, Nimmannitya P, et al. Transorbital endoscopic approach for repair of frontal sinus cerebrospinal fluid leaks: case-series. Laryngoscope. 2021;131:1753-1757.