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Cerebrospinal Fluid Rhinorrhoea
Endoscopic approach
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| 1. Right nasal cavity. The accumulation of the csf, colored by the infusion of fluorescein in the subdural space, can be discerned. | 2. Cutting the uncinate process prior to its removal. |
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| 3. Creating the maxillary antrostomy. | 4. Removal of the bulla ethmoidalis. |
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| 5. Opening the basal lamella of the middle turbinate. | 6. Entering the superior nasal meatus. The superior turbinate can be seen in contact with a large posterior ethmoidal cell. |
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| 7. Removal of the anterior wall of the posterior ethmoidal cell. Its natural ostium is seen. | 8. Transection of the lower third of the superior turbinate. |
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| 9. Enlargement of the sphenoidal ostium. | 10. After removal of the anterior wall of the sphenoid sinus, a small meningocele is seen. |
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| 11. Elevation of the mucosa around the neck of the meningocele. | 12. Continuing the removal of the bone lamella in the region of the posterior ethmoidal cells in contact with the skull base. |
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| 13. Removal of the agger nasi cell to gain access to the frontal sinus. | 14. Leakage of csf colored with fluorescein in the area of the frontal recess. |
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| 15. The point of leakage of csf in the roof of the suprabullar cell in proximity to the frontal sinus. | 16. Elevation of the mucosa around the margin of the bone deficit with a round knife. |
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| 17. The bone deficit is seen. | 18.Removal of the meningocele of the sphenoid sinus with a sickle knife. |
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| 19. Leakage of csf colored by the fluorescein from the bone deficit in the roof of the sphenoid sinus. | 20. Infusion of fibrin glue. |
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| 21. Covering the area with a fascia lata graft. | 22. Covering the graft with absorbable material. |
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| 23. Repeating the procedure with infusion of fibrin glue in the area of the defect of the suprabullar cell. | 24. Using the rest of the fascia lata graft. |
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| 25. Covering the graft with absorbable material. | 26. Reposition of the axillary flap. |
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| 27. Loose package with Vaseline gauzes. |
