Handling of CSF fistulae of the lateral lamella of the cribiform plate

Abstract

Background: Cerebrospinal fluid (CSF) fistulae towards the rhinosinusal region result from breaks in the osteo-meningeal structure that forms the anterior floor of the skull base. Diagnosis must be confirmed with laboratory and imaging support, in order to reduce errors. As a result of the advance of endoscopic techniques, ORL specialists have become familiar with the skull base and together with neurosurgeons participate in the treatment of pathologies of this area. The anterior cranial fossa contains olfactory sulci and the openings for the olfactory fibers, and thus constitutes a weak point of the skull. The lateral lamella of the cribiform plate articulates with the frontal bone. This joint usually shows zones of low osseus density, which is sometimes normal but need to be carefully examined when spontaneous fistulae are suspected, without ruling out other paranasal cavities or the ear. Aim: To describe the repair technique of lateral lamella fistula using endoscopic endonasal surgery. Method: The same surgical technique was used in three patients. A detailed report of the technique is given, and the fisiopathology, diagnosis and treatment of this pathology for the 3 cases is analyzed. Results: Postsurgical follow up of the three cases was between 12 and 18 months, with no recidivation observed.