Middle Turbinectomy Complicated by Cerebrospinal Fluid Leak Secondary to Ethmoid Encephalocele: Transethmoid Repair

Abstract

The value of middle turbinectomy for cephalalgia in carefully selected patients has been established. Although surgical treatment for middle turbinate syndrome is usually easy and safe, it may result in complications especially in the presence of unrecognized malformations of the anterior skull base. In the patient presented, cerebrospinal fluid rhinorrhea that was due to an ethmoid encephalocele occurred 1 month following surgery. An intranasal, transethmoid subfrontal craniotomy was devised to repair this defect under direct vision without subjecting the patient to the added risks of subfrontal craniotomy through external incisions. The case is reported to highlight an uncommon surgical hazard and a new approach to its repair and to address questions regarding the adequacy of the standard preoperative evaluation.