Extended Extradural Anterior Skull Base Approach for Management of Post-Traumatic Cerebrospinal Fluid Rhinorrhea

Background: Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition that still presents a major chal-lenge in terms of its diagnosis and management. It is estimated that meningitis develops in approximately 10%-25% of patients with this disorder, and 10% of them die as result. Approximately 80% of all cases of CSF rhinorrhea are caused by head injuries that are associated with cranial frac-tures. Aim of Study: To evaluate the technique and perioperative management for cerebrospinal fluid (CSF) leak following an-terior skull base fracture via extradural anterior skull base ap-proach. Patients and Methods: This study was executed at the Department of Neurosurgery of Benha University hospitals, Egypt from June 2024 to December 2024. This study included patients with post-traumatic CSF rhinorrhea following signif-icant anterior skull base fractures treated surgically using an extended extradural anterior skull base approach. Analysis was done on the information from radiological and medical records, surgical methods, repair methods, perioperative care, surgical results, and postoperative monitoring. Patients were monitored for postoperative complications and the result of CSF leaks. Frequencies and percentages were used to display the data. Results: Twenty-five patients were comprised in this study. The mean age of the patients was 41.5 years (range 30-53 years). The remaining 18 patients with chronic or recurring CSF rhinorrhea underwent repair surgery 2 to 3 weeks follow-ing the initial trauma, whereas seven patients underwent sur-gery within two weeks. The mean duration of the follow-up was six months. All of the patients experienced numerous fractures in the anterior skull base. The primary objective of the surgical procedure was to establish a watertight barrier around the dura. In 14 patients, the frontal peri-cranial flap was employed alone, whereas in 8 patients, it was joined with the temporalis muscle and/or its fascia. Free fascia Lata graft was used instead in the rest 3 patients. The patients were all discharged without any evidence of a CSF leak. Mortality was absent from this series. The most prevalent complication was bilateral anosmia. At the follow-up, 3 patients experienced recurrent CSF leaks, while 2 cases experienced postoperative infections. Conclusion: Anterior prolonged intracranial extradural ap-proach is frequently necessary for the aggressive treatment of traumatic CSF rhinorrhea with substantial anterior skull base fractures. Vascularized tissue flaps are effective grafts for the rebuilding of the anterior cranial base, either independently or in conjunction with the temporalis muscle and accompanying fascia. Additionally, sometimes the fascia Lata can be used as a free autologous graft. The method is often reserved for in-dividuals who have sustained anterior skull base injuries and experience post-traumatic cerebrospinal fluid rhinorrhea.