The endoscopic-assisted trephination approach for repair of frontal sinus cerebrospinal fluid leaks.

INTRODUCTION Endoscopic techniques have been used extensively for the treatment of sinonasal skull base defects and resulting cerebrospinal fluid (CSF) leaks. Endoscopic surgery allows for improved visualization, high success rates, reduced morbidity, and shorter hospital stays. Most ethmoid and sphenoid skull base defects can be repaired endoscopically, but endoscopic repair of frontal sinus defects remains challenging. For that reason, many frontal sinus defects have typically been approached by way of a frontal craniotomy or frontal osteoplastic approach. This article describes the use of a frontal sinus trephination for the management of frontal sinus skull base defects. The trephination technique can allow direct access to most portions of the frontal sinus, allowing straightforward exposure for the treatment of many types of frontal sinus pathologies and skull base defects.