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Cerebrospinal Fluid Rhinorrhoea

Endoscopic approach

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.
3. Creating the maxillary antrostomy. 4. Removal of the bulla ethmoidalis.
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.
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.
9. Enlargement of the sphenoidal ostium. 10. After removal of the anterior wall of the sphenoid sinus, a small meningocele is seen.
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.
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.
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.
17. The bone deficit is seen. 18.Removal of the meningocele of the sphenoid sinus with a sickle knife.
19. Leakage of csf colored by the fluorescein from the bone deficit in the roof of the sphenoid sinus. 20. Infusion of fibrin glue.
21. Covering the area with a fascia lata graft. 22. Covering the graft with absorbable material.
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.
25. Covering the graft with absorbable material. 26. Reposition of the axillary flap.
27. Loose package with Vaseline gauzes.