J Neurol Surg A Cent Eur Neurosurg 2015; 76(06): 433-437
DOI: 10.1055/s-0034-1389368
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Supraorbital Keyhole Approach to the Skull Base: Evaluation of Complications Related to CSF Fistulas and Opened Frontal Sinus

Firas Thaher
1   Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
Nikolai Hopf
1   Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
Anne-Katrin Hickmann
1   Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
Peter Kurucz
1   Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
Markus Bittl
1   Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
Hans Henkes
2   Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
Guenther Feigl
1   Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
› Institutsangaben
Weitere Informationen


31. August 2013

23. Mai 2014

27. Juli 2015 (online)


Aim Cerebrospinal fluid (CSF) rhinorrhea due to a breach in the frontal sinus (FS) presents one of the main postoperative complications of the supraorbital keyhole approach. The goal of this study was to further analyze the actual surgical morbidity and potential risk for patients due to an opened FS after a surgery via a supraorbital craniotomy and compare the results with data published in the current literature.

Methods and Patients A total of 350 consecutive patients who underwent surgeries via the supraorbital keyhole approach for various lesions were included in this retrospective study. Information on clinical history, neurologic symptoms, surgical approach, and postoperative complications was obtained retrospectively by a review of the patients' charts, the radiologic reports, and a thorough review of pre- and postoperative cranial computed tomography (CCT) imaging.

Results The frequency of CSF rhinorrhea after this type of craniotomy in the literature is reported to range between 0% and 9.1%. In this study, analysis of postoperative CCT scans revealed that 88 patients (25.1%) showed a radiographic breach of the FS. Only 8 of these patients (2.3%) developed a CSF leak with rhinorrhea postoperatively. In all cases conservative treatment with lumbar drainage failed, and therefore a surgical revision for permanent closure was required. Only one patient (0.3%) with a CSF leak also developed meningitis.

Conclusion Inadvertent opening of the FS during the supraorbital craniotomy is a common surgery-related morbidity; however, the risk for the patient to develop a potentially dangerous meningitis was found to be minimal.

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