Endoscopic repair of supraorbital ethmoid cerebrospinal fluid leaks.

OBJECTIVE

To examine the clinical and anatomical characteristics of patients with supraorbital ethmoid (SOE) cerebrospinal fluid (CSF) leaks and encephaloceles and identify specific considerations unique to their management.

METHODS

Retrospective review of patients who underwent repair of SOE CSF leaks at our institution from 2003 to 2007.

RESULTS

The majority of patients were women (5/8), middle-aged (mean: 54.9 years) and had a high body mass index (mean 42.3). Intracranial pressures (ICPs) were elevated in 6/8 patients. Anatomically, 6/8 patients had defects medial to the medial orbital wall (MOW; mean distance: 4.15 mm) and 2/8 had defects lateral to the MOW (mean distance: 8.14 mm). Seven out of 8 were successfully repaired endoscopically, and 1 patient with a lateral defect required an adjunctive trephination.

CONCLUSIONS

Patients with spontaneous SOE CSF leaks have unique clinical characteristics that include obesity and elevated ICP. Extension of a skull base defect lateral to the MOW and a narrow anterior-posterior diameter of the frontal recess are technical obstacles to endoscopic repair and may necessitate an adjunctive external approach.