Introduction When evaluating a patient for a cranial base cerebrospinal fluid (CSF) leak, the history and physical examination are critical steps to determine the diagnosis, cause, and localization. Establishing the diagnosis of CSF rhinorrhea can be challenging because there is…
Introduction Cerebrospinal fluid (CSF) rhinorrhea is the drainage of spinal fluid from the intracranial space through the nose via the paranasal sinuses. The condition was initially described in the second century by Galen of Pergamon (130–200 ad ), who identified…
Introduction ▪ The osteoplastic flap with obliteration of the frontal sinus was considered the mainstay of surgical management of the frontal sinus in the 1950s and 1960s. ▪ The osteoplastic approach to the frontal sinus was first described in 1894…
Introduction ▪ Modern trephination of the frontal sinus was first described in 1884 by Ogston. ▪ Since the 1980s, endoscopic sinus surgery has been considered the standard of care for the initial surgical management of frontal sinus disease, except in…
Introduction ▪ Advances in endoscopic sinonasal surgical techniques and instrumentation have led to an expansion in the size and diversity of skull base lesions that are amenable to an entirely endoscopic resection. However, one of the requisites for successful removal…
Introduction ▪ Successful management of malignant clival pathology extending into the posterior fossa continues to be a formidable challenge to the skull base surgeon. ▪ Classically, the clivus and posterior fossa have been approached using lateral and/or transoral-transpalatal routes. ▪…
Introduction ▪ Endoscopic approaches to intracranial tumors of the planum and sella are increasingly prevalent secondary to improved panoramic visualization, improved tumor resection, increased working angles, and decreased intranasal complications. ▪ Approaches to the sphenoid planum and sella turcica require…
Introduction ▪ The endoscopic resection of sellar and suprasellar tumors involves access to the sella via dissection through the sphenoid sinus. ▪ These procedures are often done in a combined operation with both a neurosurgeon and otolaryngologist and thus employ…
Introduction ▪ Dandy, in 1926, was the first to report a transcranial technique for the closure of a cerebrospinal fluid (CSF) leak using a fascia lata graft. ▪ Open approaches were associated with morbidities, including seizures, memory deficits, and intracranial…
Introduction ▪ Cerebrospinal fluid (CSF) rhinorrhea originating near the cribriform plate results from the breakdown of barriers separating the subarachnoid space and the paranasal sinuses. This may result from traumatic, iatrogenic, neoplastic, congenital, and inflammatory processes. ▪ A CSF leak…