Endoscopic Repair of Lateral Sphenoid Recess Cerebrospinal Fluid Leaks

Abstract

Endoscopic repair of anterior cranial base has been widely reported. However there is still no uniformity in the technique of endoscopic repair of lateral sphenoid cerebrospinal fluid (CSF) leaks. To highlight the management of CSF leak or encephalocele in the lateral sphenoid recess and relate our experiences. We retrospectively reviewed the medical records of all our patients who underwent an endoscopic repair of CSF leaks in the lateral sphenoid recess during the period from September 2003 to January 2010 at our tertiary hospital. Fifteen cases with CSF leaks/encephalocele that were repaired by the endoscopic approach were included. The majority of our cases were spontaneous leaks. In all our cases we approached the site of defect by an end on approach. All our patients were successfully treated in the first attempt. Endoscopic repair of lateral sphenoid recess has shown better surgical outcome with reduced morbidity.

Endoscopic repair of lateral sphenoid Encephaloceles: a case series

“…They also presented four of their representative cases, with no recurrent CSF leak after endoscopic repair. Kirtane et al [ 13 ] presented their series of 15 lateral sphenoid CSF leaks, all of which were repaired successfully at the first attempt. Interestingly, their series included seven male subjects and eight female subjects.…”

Management of spontaneous cerebrospinal fluid leaks of the sphenoid sinus: our experience

“…Several authors have achieved a high long-lasting closure rate without intracranial pressure recording and treatment. 4,11,35,[36][37][38][39] Other authors have found that uncontrolled intracranial pressure and obesity account for the recurrence. 10,12,[40][41][42][43] Woodworth et al reported that three patients with a failed cerebrospinal fluid closure had a documented ventriculoperitoneal shunt malfunction, suggesting that elevated intracranial pressure contributed to the recurrence.…”

“…Lumbar puncture is an invasive, uncomfortable procedure which may rarely be complicated by pneumocephalus and meningitis. Several authors have achieved a high long-lasting closure rate without intracranial pressure recording and treatment 4 , 11 , 35 , 36 – 39 . Other authors have found that uncontrolled intracranial pressure and obesity account for the recurrence 10 , 12 , 40 – 43 .…”

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

“…Kirtane et al performed uncinectomy, anterior and posterior ethmoidectomy, cutting off posterior end of middle turbinate, widening of sphenoidotomy laterally to reach lateral recess, and Hadad flap for covering the defect. 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.…”