Endoscopic Endonasal Repair of Sphenoid Sinus Cerebrospinal Fluid Leaks: Our Experience

Abstract

Endoscopic endonasal approaches are becoming increasingly popular over transcranial approaches for repair of cerebrospinal leak defects. Sphenoid sinus CSF leaks pose a significant challenge and carry the risk of life-threatening intracranial complications. Their management depends upon identifying the leak using imaging techniques followed by intraoperative endoscopic localization. Our experience in the endoscopic endonasal management of sphenoid sinus CSF leaks is reported in this paper.

Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

“…6,10,26,27 In contrary, so many prior unsuccessful open approaches in the management of SSLR defects have been successfully treated using the endoscopic endonasal transpterygoid techniques, as described in this study and reported in the literature by others. 12,28 The outcomes of the present case-series together with other results of success rates higher than 90% 15,16,28 remain superior to previous series involving external approaches with a high rate (up to 40%) of failure. 6,26,29 Moreover, our complication rate was very low (1%) and well below the morbidity for open procedures.…”

“…However, one patient with temporary numbness in the ipsilateral hard palate was free of this symptom 3 years after the surgery. Other studies using the same technique 15,16,39 reported a 100% success rate without any reported significant nerve injuries.…”

“…[12][13][14] Increasingly, the endoscopic endonasal transpterygoid approach (EETPA) is utilized as a direct surgical corridor allowing multilayer reconstruction and creation of a large sphenoidotomy to allow for a more physiological outflow from the sphenoid rather than obliteration. 15,16 In the present study, we evaluate the management and outcomes of CSF leaks located in the SSLR, repaired via endoscopic transpterygoid methods in our 20-year experience.…”

Management of a pediatric patient with spontaneous cerebrospinal fluid leak in the lateral recess of sphenoid sinus and meningoencephalocele: A case report and literature review

“…In addition, non-invasive imaging modalities such as CT and MR Cisternography are crucial to accurately identify the site of leak. Furthermore, CSF leak from the sphenoid sinus is to be suspected whenever fluid gushes with a forward tilt of the head (positive Tea-pot sign) [ 12 ].…”

Management of cerebrospinal fluid leak in the lateral recess of the sphenoid sinus with transpterygoid approach: A case report

“…The teapot sign test was carried out on patients with positive results [11] , followed by a handkerchief test that did not leave a mark and did not change the stiffness of the handkerchief so that a CSF leak was suspected [7] . Identification of suspicious CSF leak includes the teapot sign test, handkerchief test, and β2-transferrin [12] .…”