Endonasal Endoscopic Repair of Sternberg's Canal Cerebrospinal Fluid Leaks

Castelnuovo, Paolo; Dallan, Iacopo; Pistochini, Andrea; Battaglia, Paolo; Locatelli, Davide; Bignami, Maurizio

doi:10.1097/01.mlg.0000251452.90657.3a

Cited by 123 publications

(130 citation statements)

References 13 publications

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“…A pesar de signos y síntomas de hipertensión endocraneana en estos individuos los cuales concuerdan con el origen espontáneo, existen autores que han propuesto un origen congénito como causa de esta patología 12,19 . La embriología del hueso esfenoides sugiere que la fusión del ala esfenoidal, la base, el techo y los centros de osificación existen cerca del receso lateral del seno esfenoidal.…”

Section: Discussionunclassified

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Fístula de líquido cefalorraquídeo del receso lateral de seno esfenoidal. ¿Es el canal de Sternberg un defecto real?

Morales

Osorio

Cantero

2017

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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Section: Discussionunclassified

“…Se realiza planificación quirúrgica con uso de fluoresceína al 5% según lo descrito en la literatura nacional e internacional 9-10 , uso de injertos autó-logos como son la fascia lata y grasa [11][12] , tiempo quirúrgico con técnica endoscópica con acceso transpterigoideo (Figuras 4-6).…”

Section: Caso Clínicounclassified

Fístula de líquido cefalorraquídeo del receso lateral de seno esfenoidal. ¿Es el canal de Sternberg un defecto real?

Morales

Osorio

Cantero

2017

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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“…Lateral craniopharyngeal canal (Sternberg's canal) is a concept proposed by Maximilian Sternberg in 1888, which refers to the sphenoid dysplasia, appeared in the embryonic fissure (3, 6,12). Lateral craniopharyngeal canal is only covered by a weak connective tissue.…”

Section: █ Case Reportmentioning

confidence: 99%

“…Spontaneous rhinorrhea is very rare. Cerebrospinal fluid (CSF) fistula (rhinorrhea) requires 2 anatomical conditions; first is the dural tear and the second is anatomical link with a sinus or nasal cavity.Lateral craniopharyngeal canal (Sternberg's canal) is a concept proposed by Maximilian Sternberg in 1888, which refers to the sphenoid dysplasia, appeared in the embryonic fissure (3,6,12). Lateral craniopharyngeal canal is only covered by a weak connective tissue.…”

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confidence: 99%

Lateral craniopharyngeal canal: anatomical cause of spontaneous rhinorrhea -a case report and literature review

Jing

Zhao²,

Zhao³

et al. 2014

Turkish Neurosurgery

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Surgery is the only effective treatment method of spontaneous rhinorrhea. Transcranial approach and endoscopic transnasal approach are the surgical options. In recent years, a small amount of similar cases were reported in the literature (4,10,11).We report a patient with spontaneous rhinorrhea who had a lateral craniopharyngeal canal and the brain tissue protruded into the sphenoid sinus through this canal. The patient underwent surgical treatment via pterional craniotomy and recovered well after a follow-up period of 15 months. █ CASE REPORTA 58 year-old male patient admitted to our clinic for a 6 month history of "repeated fluid drainage from the left nasal cavity". The fluid was clear, aggravating as bow or bent, without headache and fever. His neurological examination was normal.█ INTRODUCTION R hinorrhea is common after trauma or operations. Spontaneous rhinorrhea is very rare. Cerebrospinal fluid (CSF) fistula (rhinorrhea) requires 2 anatomical conditions; first is the dural tear and the second is anatomical link with a sinus or nasal cavity.Lateral craniopharyngeal canal (Sternberg's canal) is a concept proposed by Maximilian Sternberg in 1888, which refers to the sphenoid dysplasia, appeared in the embryonic fissure (3,6,12). Lateral craniopharyngeal canal is only covered by a weak connective tissue. Its incidence is low (about 1/35,000). This canal is an important anatomical factor on the protrusion of brain tissue into the sphenoid sinus through the sphenoid sinus wall (3). Spontaneous CSF leakage may easily develop through the dural defect and lateral craniopharyngeal canal because it is a narrow passage and repeated impacts of CSF facilitate protrusion of the brain tissue into the sphenoid sinus.The aim of this report is to investigate the pathogenesis and surgical treatment of encephalocele located in the sphenoid sinus and presented with spontaneous rhinorrhea. The data of a patient with sphenoid sinus encephalocele was analyzed in association with the review of literature. The patient admitted to our clinic with rhinorrhea from the left nasal cavity. Cranial magnetic resonance imaging revealed bone defects in the left sphenoid sinus wall, and the presence of brain tissue and cerebrospinal fluid (CSF) in the sphenoid sinus. The patient underwent dural repair via left pterional approach. Rhinorrhea disappeared after surgery. The pathogenesis of the encephalocele in the sphenoid sinus is not clear. It may be related to the presence of lateral craniopharyngeal canal, extra-gasification in the sphenoid sinus, high intracranial pressure or other factors. It is very important to diagnose accurately the source of CSF fistula in preoperative period, choose the specific operation technique, and follow-up the patient for a long time period.

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“…When conservative management fails, usually at the end of two weeks, surgical management of rhinorrhea is mandatory in traumatic cases (16,28). (7,10,18,19,22,29). A connection to the subarachnoid space, most likely associated with a disruption of the arachnoid and dura mater with accompanying bone defect, is a prerequisite for CSF leak and inevitably carries a risk for ascending infection to the intracranial space (15,25,26,31).…”

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confidence: 99%

Endoscopic endonasal cerebrospinal fluid leak repair on the ventral midline skull base: a single neurosurgical center experience

İşler

Ahmedov²,

Akgün³

et al. 2017

Turkish Neurosurgery

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CSF leaks have been grouped into three distinct etiologic categories, namely, traumatic, spontaneous, and iatrogenic (due to previous operation). Furthermore, each group has been subdivided into acute and delayed types (6). The first line of treatment is surgery in all cases of spontaneous etiology and in most cases of iatrogenic cause of skull base CSF leak (36,38). On the contrary, initial conservative management has been advocated for traumatic CSF leaks (8,12). When conservative management fails, usually at the end of two weeks, surgical management of rhinorrhea is mandatory in traumatic cases (16,28). (7,10,18,19,22,29). A connection to the subarachnoid space, most likely associated with a disruption of the arachnoid and dura mater with accompanying bone defect, is a prerequisite for CSF leak and inevitably carries a risk for ascending infection to the intracranial space (15,25,26,31). AIM:To present the results of endoscopic endonasal repair of ventral midline skull base cerebrospinal fluid (CSF) leak (VMSBL) at our institution and to discuss the technique and results from a neurosurgical perspective. MATERIAL and METHODS:A retrospective analysis of all VMSBL cases that underwent endoscopic endonasal skull base approach (EESBA) for CSF leak repair at a single tertiary neurosurgical center was performed. Twenty six patients with an average age of 44.4 (range: 17-63) years were included in the study. RESULTS:The etiology of VMSBL was spontaneous in 16 patients, traumatic in 7, and iatrogenic in 3. The leakage site was the cribriform plate in 13 patients, ethmoidal cells in 7, and sphenoid sinus in 3. There were multiple leaks in 3 patients. This approach for VMSBL repair was performed 28 times on 26 patients. The success rate was 88.5% (23/26 patients) after primary endoscopic repair and 96% after the second attempt. The location of the leakage site relative to the upper attachment of the middle turbinate played a crucial role in the anteriorly located VMSBL, which made an impact on the surgical repair plan. All the 16 cases with accompanying meningoencephaloceles were treated successfully by EESBA. Use of vascularized pedicled flaps to support the repair site resulted in 100% success after primary repair. CONCLUSION:EESBA is safe and highly effective and can be a first-line surgical treatment option for VMSBL. In addition, it enables adequate reconstruction of ventral midline skull base meningoencephaloceles regardless of size and location.

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Endonasal Endoscopic Repair of Sternberg's Canal Cerebrospinal Fluid Leaks

Abstract: The transethmoidal-pterygoidal-sphenoidal approach provides a wide, safe, and direct route to the lateral recess of the sphenoid sinus. Multilayered reconstruction of the skull base defects must be considered the first option for this kind of lesion.

Cited by 123 publications

References 13 publications

Fístula de líquido cefalorraquídeo del receso lateral de seno esfenoidal. ¿Es el canal de Sternberg un defecto real?

Fístula de líquido cefalorraquídeo del receso lateral de seno esfenoidal. ¿Es el canal de Sternberg un defecto real?

Lateral craniopharyngeal canal: anatomical cause of spontaneous rhinorrhea -a case report and literature review

Endoscopic endonasal cerebrospinal fluid leak repair on the ventral midline skull base: a single neurosurgical center experience

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