Encephaloceles and cerebrospinal fluid (CSF) leaks of the frontal sinus may result from congenital, traumatic, spontaneous, or neoplastic causes. Paramount to success is adequate preoperative planning with accurate history, physical exam, endoscopy, imaging, and testing to confirm location of the leak and origin of the disease. Generally, frontal sinus CSF leaks may be addressed endoscopically with favorable anatomy, proper surgical technique, and appropriate equipment. Open surgical approaches (eg, osteoplastic flap) are often required for superior/lateral defects or if the surgeon is not experienced with endoscopic frontal sinus techniques.
Key points
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Comprehensive preoperative workup including history, physical, imaging, and confirmatory laboratory testing will help determine the cause for cerebrospinal fluid leak or encephalocele.
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Hemostasis with topical and infiltrative vasoconstrictors aids in visualization and decreases risk of surgical error.
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Careful and complete exposure surrounding the encephalocele helps the surgeon control bleeding and permits greater working area.
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Aggressive postoperative antiemetics, stool softeners, and nasal packing support the repair against spikes in intracranial pressure in the early postoperative period.
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Vigilant postoperative endoscopy with debridement increases the chance of frontal sinus patency long-term.
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