ИСТИНА

Defects localized in the frontal sinus pose a unique problem for rhinosurgeons due to a great number of anatomic variants of the nasofrontal duct and sinus itself. Objective: to synthesize and analyze the results of treating cerebrospinal fluid rhinorrhea due to frontal sinus defects with the application of endonasal endoscopic and combined intra–extranasal approaches. Materials and Methods: A retrospective review of a series of 43 patients with nasal cerebrospinal fluid from the frontal sinus, treated at our neurosurgical center between 2001 and 2018. The study reviewed their demographics, clinical data, defect localization and its size, treatment details. Treatment results were assessed according to the analysis of disease relapses and complications. Results: In a series of 43 patients with difficult frontal sinus defects 19 (44%) had spontaneous defects, 13 (30%) had iatrogenic defects, 11 (26%) had traumatic defects. In our series of patients, the endonasal endoscopic approach was chosen in 28 (65%) cases. The combined approach was utilized to treat 15 (35%) patients. The success of reconstruction with endoscopic endonasal approach is 86% (24 of 28) with a combined approach of 93% (14 of 15). Complications in these approaches occur in 4-20% Conclusion: Endoscopic endonasal and combined approaches are the methods of choice for reconstruction of complex defects of the skull base in the frontal sinus, as they are effective and safe. The choice of access depends on anatomic features frontal recess and frontal sinus and the location of the defect. Key Words: frontal sinus, cerebrospinal fluid rhinorrhea, endoscopic approach, combined intra–extranasal approach, skull base