Endoscopic repair of supraorbital ethmoid cerebrospinal fluid leaks

Objective: To examine the clinical and anatomical characteristics of patients with supraorbital ethmoid (SOE) cerebrospinal fluid (CSF) leaks and encephaloceles and identify specific considerations unique to their management. Methods: Retrospective review of patients who underwent repair of SOE CSF leaks at our institution from 2003 to 2007. Results: The majority of patients were women (5/8), middle-aged (mean: 54.9 years) and had a high body mass index (mean 42.3). Intracranial pressures (ICPs) were elevated in 6/8 patients. Anatomically, 6/8 patients had defects medial to the medial orbital wall (MOW; mean distance: 4.15 mm) and 2/8 had defects lateral to the MOW (mean distance: 8.14 mm). Seven out of 8 were successfully repaired endoscopically, and 1 patient with a lateral defect required an adjunctive trephination. Conclusions: Patients with spontaneous SOE CSF leaks have unique clinical characteristics that include obesity and elevated ICP. Extension of a skull base defect lateral to the MOW and a narrow anterior-posterior diameter of the frontal recess are technical obstacles to endoscopic repair and may necessitate an adjunctive external approach.