Meningiomas Involving the Orbit: Surgical Technique and Our Series of 17 Patients

Introduction: CSF leak following head trauma or prior surgical procedures has a risk for meningitis and must be treated promptly. Recently many publications have reported repair by endoscopic endonasal techniques. We present our experience with subcranial craniotomy and anterior skull base reconstruction and highlight the advantages of this technique in specific indications.

Methods: Between November 2003 and December 2007, 19 patients aged 10 to 60 years old underwent subcranial surgery for CSF leak from the anterior skull base. The main leak causes were trauma (15 cases) and post other surgical procedures (4 cases). Eleven cases had complex fractures with more than one fracture. The most common leak sites were the cribriform-ethmoidal area (15 cases), frontal sinus (9 cases), and sphenoid sinus (8 cases). Nine patients had had previous surgical attempts for treating the leak that failed.

Results: There were no postoperative leaks after the subcranial procedure. There was no mortality in our series. Short-term complications included one case of meningitis, one tension pneumocephalus that required aspiration, and two cases of pneumocephalus that resolved spontaneously. Long-term complications were minor.

Conclusions: Subcranial craniotomy and anterior skull base reconstruction is associated with high sealing rates and low morbidity and mortality. The main advantage over endoscopic procedures is in treating complex anterior skull base fractures.