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Arq Neuropsiquiatr. 2016 Jul;74(7):580-6. doi: 10.1590/0004-282X20160087.

Endoscopic endonasal management of cerebrospinal fluid rhinorrhea after anterior clinoidectomy for aneurysm surgery: changing the paradigm of complication management.

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Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;
DFVneuro, São Paulo SP, Brasil;
Hospital Professor Edmundo Vasconcelos, Centro de Otorrino e Fonoaudiologia, São Paulo SP, Brasil;
Hospital Israelita Albert Einstein, São Paulo SP, Brasil.


Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.

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