Minimally invasive approach for lesions involving the frontal sinus

62 SAJS VOL. 53 NO. 2 JULY 2015 Cerebrospinal fluid (CSF) leaks secondary to frontal sinus fractures are usually repaired by neurosurgeons through a standard craniotomy or osteoplastic flap procedure with obliteration of the frontal sinus or cranialisation of the intracranial contents (removal of the posterior wall of the frontal sinus and allowing the frontal lobe to rest against the anterior wall of the sinus).[1] The objective of surgery is to stop or avoid a potential CSF leak and to avoid the risk of future meningitis. The frontal sinus is usually obliterated during the osteoplastic flap procedure, separating it from the rest of the paranasal sinuses and nasal cavity. Alternatively an endoscopic endonasal approach to frontal sinus CSF leaks can be used. This requires a modified Lothrop procedure for access, necessitating removal of the superior part of the nasal septum, anterior to the first olfactory fibre, and resection of the floor of both frontal sinuses to visualise the posterior wall of the frontal sinuses. This requires advanced technical skills and expensive equipment with operating times averaging 3 4 hours. If the modified Lothrop procedure fails, repair is problematic using the traditional approaches since no contained cavity exists to obliterate the sinus. Problematic sinus drainage can occur with stenosis of the neo-ostium even with a modified Lothrop procedure.[3]