Endoscopic repair of anterior cranial fossa dural defect in an unusual case of frontal sinus trauma.

Because of its vulnerable location, the frontal sinus may be involved in several types of maxillofacial trauma. This involvement may cause fractures of the anterior and/or posterior walls of the sinus,1 lodgment of foreign bodies in the sinus,2 and anterior cranial fossa dural tears, which may result in cerebrospinal fluid (CSF) rhinorrhea, meningitis, aerocele, and other intracranial complications.2 Undisplaced fractures of the anterior wall of the frontal sinus may require no treatment at all, whereas displaced fractures of the anterior wall and fractures of the posterior wall with intracranial problems require surgical intervention. There are several methods of repairing dural tears with either intracranial or extracranial techniques. Intracranial approaches with a craniotomy have success rates as low as 60% and have high morbidity with the likelihood of postoperative anosmia.2 This finding stimulated development of other surgical approaches, and in 1948 Dohlman described an extracranial approach. Later, endonasal approaches and endoscopic management of CSF fistulas were reported.3 We report on a patient with frontal sinus trauma involving both the anterior and posterior walls and the dura of the anterior cranial fossa, and we present endoscopic repair of the dural defect.