Objective: In the developing countries where surgical endoscopy is still not readily available,
intracranial surgery remains the only pragmatic option for repairing cerebrospinal
fluid (CSF) rhinorrhea. Even such surgery can be forbiddingly difficult in a resource-poor
setting.
Design: A simple intracranial extradural surgical technique used in a developing country
for the frontobasal repair of CSF rhinorrhea is presented. This involves the dissection,
preservation, elevation, and extradural imbrication of a wide-based pericranial flap
to seal dural leaks and also exclude the frontobasal intracranial space from the naso-orbital
roof.
Patients/Materials and Methods: Preoperative clinical-radiological characteristics and postoperative outcome of a
prospective consecutive case series of CSF rhinorrhea repaired with this technique
shall be presented.
Results: Over an 18-month period, six consecutive cases of CSF rhinorrhea in an African developing
country were successfully repaired with this technique. Five of them were from posttraumatic
complex skull base fracture with associated tension pneumocephalus. Cessation of CSF
leak was immediate in all six cases. Anosmia was the only procedure-related complication
to date. No other perioperative adjunct was used to aid this surgical outcome. Recurrence
of CSF leak has been nil in a follow-up period ranging from 1 to 18 months (mean,
9 months).
Conclusions: This simple surgical technique appears effective for the surgical repair of frontobasal
CSF leak. It holds great attraction for skull base surgical practice in resource-poor
settings.
