Extradural removal of the crista galli to prevent CSF rhinorrhea after the basal interhemispheric approach: A technical note

Abstract

Abstract Purpose Crista galli removal during the basal interhemispheric approach is a possible cause of postoperative cerebrospinal fluid rhinorrhea because of the pneumatization of this bony ridge communicating with the frontal sinus. Crista galli can be removed either intradurally or extradurally. We discuss these techniques and describe extradural removal with the intention of preventing postoperative cerebrospinal fluid leak. Methods Representative intradural and extradural removal of the crista galli is explained. Intradural removal carries the risk of a dural defect in the anterior skull base, but extradural removal can be achieved without a dural defect. Results The anatomical characteristics of the frontal dura mater and falx cerebri allow for the removal of the crista galli without a dural defect. Conclusion Extradural removal of the crista galli is preferable to intradural removal to reduce the risk of postoperative cerebrospinal fluid rhinorrhea after the basal interhemispheric approach, especially if the crista (galli) is pneumatized.