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

Fyrmpas, Georgios; Konstantinidis, Ioannis; Selviaridis, Panagiotis; Constantinidis, J.

doi:10.1017/s0022215114001698

Cited by 12 publications

(28 citation statements)

References 40 publications

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“…Ninety-four studies were identified with complete data available on the primary and secondary leaks for endoscopic repairs. The success rate on primary repair among all the studies ranged from 0 to 97.6%, and 63 studies 4–6,9,14,17,21–25,29,30,32–34,36,39,42–49,52,53,57,59,60,62,65,68,71,72,74,76,77,80,82–87,89,93,94,97–99,105–,107,111,112,114,115 (67%) had a success rate of ≥80%. The rate of secondary leaks ranged from 2.4 to 100%, and 77 studies 4–6,9,11,14,…”

Section: Resultsmentioning

confidence: 99%

“…Independently, meningoencephaloceles or encephaloceles were associated with primary leaks in 17 studies 12,17,24,30,34,38,40,44,49,53,75,82,98,101,102,104,108 or 192 primary leaks. The distribution of the primary etiology for secondary leaks (the source of the primary leak that recurred) was available for 51 studies 4,6,9,11,12,14,17,21,23,27,29,31–40,43,45–49,52–54,56,57,59,62,65,66,68,71,72,76,80,81,86,89–91,94,…”

Section: Csf Leak Characteristicsmentioning

confidence: 99%

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A Systematic Review of Secondary Cerebrospinal Fluid Leaks

Konuthula

Khan

Signore

et al. 2017

Am J Rhinol�Allergy

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Section: Resultsmentioning

confidence: 99%

Section: Csf Leak Characteristicsmentioning

confidence: 99%

A Systematic Review of Secondary Cerebrospinal Fluid Leaks

Konuthula

Khan

Signore

et al. 2017

Am J Rhinol�Allergy

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“…Indeed, assuming that most spontaneous skull base CSF leak patients have underlying IIH, and that a CSF leak is a sign of chronic poorly controlled IIH, 3–5 one might hypothesize that the leak acts as a “pressure release valve,” providing relief of symptoms and signs of raised ICP, precluding or delaying the presentation of IIH. 22 Papilledema has been uncommonly reported at presentation in CSF leak patients, with a pooled prevalence of only approximately 5%, 3 , 6 , 23–26 but preoperative signs suggestive of raised ICP were underestimated in these studies, as these also include sixth nerve palsy and peripapillary changes of resolved papilledema. None of the previous studies provided details regarding a previous history of IIH or the presence of resolved signs of intracranial hypertension.…”

Section: Discussionmentioning

confidence: 89%

Spontaneous Skull Base Cerebrospinal Fluid Leaks and Their Relationship to Idiopathic Intracranial Hypertension

Bidot

Levy

Saindane

et al. 2020

Am J Rhinol�Allergy

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Background The association between spontaneous skull base cerebrospinal fluid (CSF) leaks and idiopathic intracranial hypertension (IIH) has been suggested, but its significance remains unclear. Objective To estimate the prevalence of IIH in spontaneous skull base CSF leak patients. Methods Systematic collection of demographics, neuro-ophthalmic and magnetic resonance imaging evaluation of spontaneous skull base CSF leak patients seen pre- and post-leak repair in one neuro-ophthalmology service. Patients with preexisting IIH were diagnosed with definite IIH if adequate documentation was provided; otherwise, they were categorized with presumed IIH. Classic radiographic signs of intracranial hypertension and bilateral transverse venous sinus stenosis were recorded. Results Thirty six patients were included (age [interquartile range]: 50 [45;54] years; 94% women; body mass index: 36.8 [30.5;39.9] kg/m2), among whom six (16.7%, [95% confidence interval, CI]: [6.4;32.8]) had a preexisting diagnosis of definite or presumed IIH. Of the remaining 30 patients, four (13.3%, 95%CI: [3.8;30.7]) had optic nerve head changes suggesting previously undiagnosed IIH, while one was newly diagnosed with definite IIH at initial consultation. One out of 29 patients with normal findings of the optic nerve head at presentation developed new onset papilledema following surgery (3.4%, 95%CI: [0.1;17.8]) and was ultimately diagnosed with definite IIH. Overall, the prevalence of definite IIH was 19.4% (95%CI: [8.2;36.0]). Conclusion Striking demographic overlap exists between IIH patients and those with spontaneous CSF leak. Definite IIH was present in approximately 20% of our patients. However, its true prevalence is likely higher than identified by using classic criteria. We therefore hypothesize that an active CSF leak serves as an auto-diversion for CSF, thereby “treating” the intracranial hypertension and eliminating characteristic signs and symptoms at initial presentation.

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“…Obliteration of the sphenoid sinus, alone or with an overlay graft/flap, is still commonly used for the repair of a CSF leaks of the sphenoid sinus, particularly in cases with limited visualization at the lateral wall of the sinus. 13,14 This technique aims to create a sphenoid sinusotomy of sufficient size to provide access to the site of CSF leak while maintaining a sphenoid rostrum adequate to hold graft material in place. Alternatively, the lateral sphenoid can be obliterated by placing a fascial and/or muscle graft between the foramen rotundum and Vidian canal to compartmentalize the lateral recess from the sphenoid sinus after ensuring that the mucosa could be completely extirpated from the SSLR.…”

Section: Discussionmentioning

confidence: 99%

“…11 Due to the adjacent cranial nerves and critical vasculature, transnasal obliteration of the sphenoid sinus without directly repairing the skull base defect is performed by most centers. [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.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

Bozkurt

Turri‐Zanoni

Coden

et al. 2019

J Neurol Surg B Skull Base

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Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure. Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach. Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients. Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

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

Cited by 12 publications

References 40 publications

A Systematic Review of Secondary Cerebrospinal Fluid Leaks

A Systematic Review of Secondary Cerebrospinal Fluid Leaks

Spontaneous Skull Base Cerebrospinal Fluid Leaks and Their Relationship to Idiopathic Intracranial Hypertension

Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

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