A 9 year old female, presented with pus discharge from the nasal bridge in the ENT opd. Further work up ncct nasal bone revealed it to be associated with nasal mass d/d frontoethmoidal encephalocele. Further MRI revealed it to be mucocele. But on repeat MRI it turn out to be epidermoid /dermoid with intracranial connections.
Combined team of ENT surgeon and Neurosurgeon had taken the case in OT and successfully removed the TM by doing small fronto ethmoidal osteotomy. No CSF leak was detected and closure done in layers. My question is what can be the best approach to prevent CSF leak for a neurosurgeon- bifrontal craniotomy or one side frontal craniotomy and placement of graftplus glue?
