Abstract
Objective
The supraorbital ethmoid and lateral frontal sinus are difficult to approach endoscopically. Their location, superior and lateral to the orbit, can make access technically challenging. In this study, we examined clinical and anatomical characteristics of patients with supraorbital CSF leaks and encepholeceles and identified specific considerations unique to their management.
Methods
Retrospective review of patients who underwent repair of supraorbital CSF leaks at our institution from 2003–2007.
Results
Eight patients were surgically treated. Seven were spontaneous leaks with an associated encepholecele and one was post-craniotomy. The majority of patients were women (5/8), middle-aged (mean: 54.9 years), and had a mean BMI of 42.3 kg/m2. Intracranial pressures were elevated in 6/8 patients and an empty sella was present in each of the 7 patients with a spontaneous leak. Anatomically, 6/8 patients had defects medial to a sagittal plane drawn through the medial orbital wall (mean distance: 4.15 mm) and 2/8 patients had defects lateral to the sagittal plane (mean distance: 8.14 mm). 7/8 were successfully repaired endoscopically and one patient with a lateral defect required conversion to a supra-orbital trephination. All defects were repaired successfully with a mean follow-up of 27.8 months.
Conclusions
Patients with supraorbital CSF leaks have unique clinical characteristics that include obesity and elevated ICP. Endoscopic repair produces acceptable results with low morbidity. Extension of a skull base defect lateral to a sagittal plane through the medial orbital wall is a technical obstacle to endoscopic repair and may require an adjunctive external approach.
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