The Precallosal interhemispheric approach for the treatment of osteomeningeal defects in the cribiform area

Solapas principales

Urculo E.1, Torres S.1, Samprón N.1, Torres P.1, Undabeitia J.1



            The subfrontal approach is the most frequently used cranial route to seal osteomeningeal defects of the anterior cranial fossa. Nevertheless, we have observed difficulties preserving the first cranial nerve and the frontal paranasal sinus when using this corridor – eirther unilateral or bilateral-. For these reasons, we now favor using the interhemispheric precallosal approach to seal leaks in the cribriform area in selected cases. To describe and analyze advantages and disadvantages of precallosal interhemispheric approach as an alternative approach to repair osteomeningeal defects in the cribriform area. Based on previous anatomical studies and surgical experience with other well-known interhemispheric approaches, we have planned a precallosal interhemispheric approach to the ethmoido-fronto-sphenoidal area of the anterior cranial fossa to treat a series of eight patients sustaining post-traumatic or spontaneous CSF-leaks originating in that area. Six patients presented with post-traumatic CSF leaks while in the remaining two they were spontaneous. Immediate sealing of the leak was achieved in seven patients using the proposed approach. One patient with persistent leak after surgery required an additional procedure. The contralateral first cranial nerve was preserved in all cases, while it was not possible to preserve the ipsilateral olfactory nerve by this approach. Unilateral olfactory function was preserved in four cases.

The interhemispheric precallosal approach is an alternative for the repair of osteo-meningeal defects in the cribriform area when olfactory function and frontal paranasal sinus preservation is desirable.

Keyword: Anterior Cranial Fossa, Cerebrospinal Fluid leak, Olfactory Nerve Diseases, Cerebrospinal Fluid Rhinorrhea Surgery..



  1. Department of Neurosurgery. Hospital Universitario Donostia. San Sebastián. Spain.