2025 Poster Presentations
P267: ANTERIOR SKULL BASE RECONSTRUCTION FOR THE MANAGEMENT OF CSF LEAKS: A TECHNICAL SERIES OF 221 FRONTAL CRANIOTOMIES
Malia McAvoy, MD, MS1; Zachary Abecassis, MD1; Varadaraya Shenoy, MD1; Rajeev Sen, MD2; Kristin Moe, MD3; Laligam Sekhar, MD1; 1University of Washington, Department of Neurological Surgery; 2New York University, Department of Neurosurgery; 3University of Washington, Department of Otolaryngology
Objective: To investigate the incidence of cerebrospinal fluid (CSF) leak after frontal craniotomies and describe skull base reconstruction techniques for prevention and treatment of CSF leaks.
Methods: We retrospectively reviewed all patients undergoing variations of frontal craniotomies for skull base lesions between 2005-2022. Demographic, clinical, radiographic and treatment outcomes data were analyzed.
Results: Two hundred and twenty one patients (mean age 51.7 years, 58.8% females) underwent variations of frontal craniotomies between 2005 and 2022. Unilateral frontotemporal craniotomy with orbital osteotomy was performed among 24.0% (53/221) of patients. Standard bifrontal approach was used in 33.5% (74/221) cases. Bifrontal craniotomies with naso-orbital bar (NOB) were performed among 35.3% (78/221) patients. Modified frontal (one-and-a-half) craniotomy with orbito-fronto-nasal osteotomy were performed among 7.2% (16/221) patients. Gross total resection was achieved among 77.8% patients. Postoperative hydrocephalus requiring ventriculoperitoneal shunt placement was present among 11.8% (26/221) of patients. Mortality within 6 months was 3.6% (8/221). Postoperative CSF leaks were observed in 3.2% (7/221) cases. Five of the 7 patients who developed CSF leak had undergone bifrontal craniotomy with NOB osteotomy. Anterior skull base reconstruction techniques used to treat the CSF leaks are described using case illustrations with long-term follow-up.
Conclusions: Incidence of CSF leaks in patients undergoing frontal and bifrontal craniotomy is 3.2%. We describe our institutional experience on anterior skull base reconstruction techniques for the management of CSF leaks in patients who undergo frontal craniotomies for the management of skull base lesions.