Sphenoid CSF leak — dumbbell graft repair

Highlights

• Border of skull base defect needs to be very clearly defined.
• Harvested temporalis fascia is placed through defect so that approximately half of the fascia lies intracranially and half lies within the sinus cavity, thus giving the appearance of a “dumbbell” shaped graft.
• This technique is most useful for repair of small skull base defects where underlay grafts of cartilage and bone can be difficult to place.
• Such small defects often have high flow CSF leaks. The dumbell fascial graft serves as a dam to seal the leak readily and permanently.