A modification of endoscopic endonasal approach for management of encephaloceles in sphenoid sinus lateral recess

Abstract

Spontaneous cerebrospinal fluid leak with meningoencephaloceles in sphenoid sinus lateral recess is challenging. Transnasal visualization of this area is difficult, especially when large pneumatization is present. External approaches to this region involve aggressive surgery and are often associated with significant morbidity. The aim of this study is to assess the real effectiveness of a modification of the endoscopic endonasal approach for their management. This is a prospective case series study and was conducted at Otolaryngology department, Ain Shams University Hospitals, Cairo, Egypt. Seven patients with spontaneous cerebrospinal fluid leak with meningoencephaloceles in the sphenoid sinus lateral recess were included. Diagnosis was confirmed by: analysis for beta-2 transferrin and imaging. They were managed with endoscopic endonasal retrograde trans-sphenoid approach described in this study with multilayered reconstruction of the defect. Mean age of our patients was 40.14 ± 8.35 years; mean BMI was 36.37 ± 2.59 kg/m. Primary empty sella was present and osteodural defect was identified in superior wall of sphenoid sinus lateral recess with punched out and regular smooth edges. Mean intra-cranial pressure was (26.42 ± 3.87 mmHO) and size of defect was less than 10 mm, mean 7.85 ± 1.34. Mean-operative time was 169.28 ± 21.87 min. The mean hospital stay was 7.42 ± 1.39 days. No cerebrospinal fluid leak recurrences were observed during follow-up period that ranged from 37 to 48 months. Endoscopic endonasal retrograde trans-sphenoid approach provides a wide, safe, and direct route to the management of sphenoid sinus lateral recess cerebrospinal fluid leak.

Assessment of variations in sphenoid sinus pneumatization in Indian population: A multidetector computed tomography study

“…Extensive pneumatization of the SS and lateral recess increases susceptibility to bony erosion and spontaneous CSF leaks in idiopathic intracranial hypertension and extension of sellar and parasellar lesions into SS [Figure 9 and 10 ]. [ 31 32 ] The radiology template that can be included in the paranasal sinus CT reporting for assessment of sphenoid sinus pneumatization is shown in .…”

Endoscopic repair of lateral sphenoid Encephaloceles: a case series

“…Additionally, the frequent chronically elevated CSF pressure and three-dimensional anatomy at this site may make durable, “water-tight” repair a surgical challenge. Several recent case series [ 1 , 2 ] have explored the use of endoscopic transsphenoidal repair, with a transpterygoid extension often necessary. Success rates are high with multilayered repair techniques and an endoscopic approach.…”

Modified Ipsilateral Endonasal Endoscopic Trans-Sphenoidal Approach to Sphenoid Sinus Lateral Recess Cerebrospinal Fluid Leak Management in Two Cases: A Technical Note

“…Modification of the transpterygoid approach has been tried by few with lesser bony drilling. 9 Techniques of approaching SSLR by trans-sphenoidal route has been described by very few. Turner et al managed six cases by EETSA or partial transpterygoid approaches to access SSLR CSF leaks.…”

“…11 El-Tarabishi et al used four-handed two nostrils endoscopic trans-sphenoidal approach. 9 Superior turbinate was resected, middle turbinate sacrificed partially, and rostrum and posterior 1 cm of nasal septum sacrificed. Bilateral sphenoidotomy was done in all cases and extended laterally to visualize the medial orbital wall and lateral wall of the sphenoid sinus.…”