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Neurosurg Focus 32 (6):Introduction, 2012

Introduction

Skull base cerebrospinal fluid fistula nial base have been particularly in vogue. Therefore, it should come as no surprise that this issue has a particular emphasis on techniques applied in these procedures to John Diaz Day, M.D.,1 and Anil Nanda, M.D., M.P.H.2 achieve satisfactory closure. This aspect of contemporary cranial base surgery has taken advantage of the unique 1Department of Neurosurgery, University of Arkansas, Fayette expertise of neurosurgeons and our otorhinolaryngology ville, Arkansas; and 2Department of Neurosurgery, Louisiana State colleagues. Our ability to traverse the naso- and oropha- University, Shreveport, Louisiana ryngeal spaces to reach the skull base and intracranial compartment has realized significant advancements in A skull base CSF fistula occurs when there is a de- the past years. New biological and structural materials as fect at the skull base and the subarachnoid space com- well as innovative vascularized tissue transfer techniques municates with the extracranial space. Galen in the 2nd have contributed equally to an enhanced ability to cre- century ad was the first to describe leakage of CSF after ate seals that prevent egress of CSF. The level of facility cranial trauma.5 The term “rhinorrhea” was coined by 3 with these techniques, built on the collective experience Thomson while describing spontaneous nasal CSF leaks of others in our field, is demonstrated in this issue. in patients. Treating CSF fistulas, whether from surgical or ac- There exist a number of constants in neurosurgery cidental trauma, remains a critical clinical and surgical with respect to achieving good outcomes for our patients. challenge. Our results are certainly not perfect; however, These include an intimate knowledge of surgical anato- a high standard is reachable with adherence to certain my, meticulous technique to avoid injury to vital tissue, principles and proficiency with contemporary techniques. sharp attention to hemostasis, and so forth. This issue of (http://thejns.org/doi/abs/10.3171/2012.5.FOCUS12164) Neurosurgical Focus deals with one of these constants that is paramount in cranial, skull base, and spinal neurosurgery, that is, exclusion of the CSF space from the Disclosure external environment. Failure to obtain adequate closure, resulting in the loss of CSF and the communication of The authors report no conflict of interest. privileged internal space with the exterior milieu, can have a disastrous influence on the eventual outcome of an References otherwise uneventful operation. Techniques to restore or 1. Dandy WE: Pneumocephalus (intracranial pneumatocele or maintain seclusion of the space occupied by CSF around aerocele). Arch Surg 12:949–982, 1926 the brain and spinal cord is the subject of this issue. 2. Grant FC: Intracranial aerocele following fracture of the The importance of closing the dural defect was skull: report of a case with review of the literature. Surg Gy- put forward by Grant in 1923.2 Walter Dandy,1 in 1926, necol Obstet 36:251–255, 1923 published the first report on the surgical repair of CSF 3. Thomson SC: The Cerebrospinal Fluid: Its Spontaneous rhinorrhea. He used muscle and fascia to close a fron- Escape from the Nose, With Observations on Its Composi- tal sinus defect. Using an endoscope in the repair of a tion and Function in the Human Subject. London: Cassell, 4 1899 skull base defect was proposed by Wigand in 1981. In 4. Wigand ME: Transnasal ethmoidectomy under endoscopical recent years endonasal endoscopic approaches to the cra- control. Rhinology 19:7–15, 1981 5. Zlab MK, Moore GF, Daly DT, Yonkers AJ: Cerebrospinal Please include this information when citing this paper: DOI: fluid rhinorrhea: a review of the literature. Ear Nose Throat 10.3171/2012.5.FOCUS12164. J 71:314–317, 1992

Neurosurg Focus / Volume 32 / June 2012 1

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