Cerebrospinal fluid rhinorrhea from the lateral recess of sphenoid sinus: More to it than meets the eye

• Published in: Neurology India 2019-01, Vol.67 (1), p.201-206
• Main Authors: Rajasekar, Gopikrishnan, Nair, Prakash, Abraham, Mathew, Felix, Vinod, Karthikayan, Arunkumar
• Format: Article
• Language: English
• Subjects: Adult; Care and treatment; Cerebrospinal fluid; Cerebrospinal Fluid Rhinorrhea - etiology; Cerebrospinal Fluid Rhinorrhea - surgery; Defects; Diagnosis; Endoscopy; Female; Humans; Hypertension; Hypotheses; Intracranial hypertension; Intracranial Hypertension - complications; Intracranial pressure; Male; Medical examination; Meningitis; Middle Aged; Neuroendoscopy - methods; NMR; Nuclear magnetic resonance; Paranasal sinuses; Patients; Respiratory tract diseases; Retrospective Studies; Sinuses; Sphenoid Sinus - surgery; Surgery; Testing; Treatment Outcome; Tumors; Visualization
• ISSN: 0028-3886; 1998-4022
• DOI: 10.4103/0028-3886.253634

Background: Cerebrospinal fluid (CSF) leak from the lateral recess of the sphenoid sinus is rare when compared to leaks from other sites. The extended endonasal approach along with a transpterygoid extension provides adequate exposure for repair of these defects. Materials and Methods: We retrospectively analyzed a series of seven patients who underwent eight transpterygoid approaches for repair of the CSF leak from the lateral recess of the sphenoid sinus. We analyzed the patient characteristics, site of leaks, type of repair done, and presence of increased intracranial pressure (ICP) in these individuals. Results: Seven patients underwent eight transpterygoid approaches for CSF leaks from the lateral recess of the sphenoid sinus. The leak was bilateral in one patient. The materials used for repair consisted of fat, fascia lata, free mucosal flap or a vascularised nasoseptal flap, and fibrin glue. Evidence of increased ICP was found in five of the seven patients. CSF diversion was needed in three of the seven patients (two ventriculoperitoneal shunt and one thecoperitoneal shunt). Conclusion: Endoscopic endonasal transpterygoid approach provides an excellent visualization of the skull-base defect and facilitates adequate instrument manipulation within the corridor, allowing successful repair of the defect with low rates of recurrence. Increased ICP can have a role in causing spontaneous CSF rhinorrhea from this location.