Lateral sphenoid sinus recess cerebrospinal fluid leak: a case series

The lateral recess of the sphenoid sinus is one of the most common sites of meningocele and spontaneous cerebrospinal fluid (CSF) leak. Despite the availability of several techniques for closure of skull base defects occurring in this location, recurrence still poses a major challenge. This report r...

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Published in:European archives of oto-rhino-laryngology 2014-09, Vol.271 (9), p.2587-2594
Main Authors: Melo, Nelson Almeida d’Ávila, Borges, Bruno Barros Pinto, Filho, Pedro Augusto Magliarelli, Godoy, Maria Dantas Costa Lima, Pereira, Larissa Vilela, de Rezende Pinna, Fabio, Voegels, Richard Louis
Format: Article
Language:English
Subjects:
Adult
Case Report
Cerebrospinal Fluid Leak - diagnosis
Cerebrospinal Fluid Leak - surgery
Female
Follow-Up Studies
Head and Neck Surgery
Humans
Magnetic Resonance Imaging
Medicine
Medicine & Public Health
Middle Aged
Natural Orifice Endoscopic Surgery - methods
Neurosurgery
Otorhinolaryngologic Surgical Procedures - methods
Otorhinolaryngology
Sphenoid Bone - surgery
Sphenoid Sinus
Tomography, X-Ray Computed
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Summary:The lateral recess of the sphenoid sinus is one of the most common sites of meningocele and spontaneous cerebrospinal fluid (CSF) leak. Despite the availability of several techniques for closure of skull base defects occurring in this location, recurrence still poses a major challenge. This report reviews the experience of surgical repair of lateral sphenoid sinus recess CSF leak at a tertiary referral center and provides a brief discussion of this rare lesion. Nine surgeries were performed for six cases of spontaneous lateral sphenoid sinus recess CSF leak (two revisions and one repair of a new defect). Two patients presented with intracranial hypertension (ICH) and four with meningocele or meningoencephalocele. The transpterygoid approach was used in two procedures. A multilayer graft was used in seven cases and a nasoseptal flap in two. Three patients received lumbar or ventricular shunts, and one received acetazolamide for ICH management. Two minor complications were recorded, and the overall surgical success rate was 78 %. We conclude that nasoseptal flaps are a valid option for repair of recurrent CSF leaks, particularly in the lateral sphenoid sinus recess. Furthermore, identification and correction of ICH plays an essential role in the success of treatment in this patient population.
ISSN:0937-4477
1434-4726
DOI:10.1007/s00405-014-3049-8