Treatment strategies for lateral sphenoid sinus recess cerebrospinal fluid leaks.
OBJECTIVE
To highlight concepts critical to achieving successful repair and avoiding intracranial complications in the treatment of cerebrospinal fluid (CSF) leaks from the lateral recess of the sphenoid sinus (LRS).


METHODS
Outcomes study.


METHODS
Tertiary referral university hospital.


METHODS
Eleven patients with LRS CSF leaks from June 2008 to June 2010.


METHODS
Endoscopic transpterygoid approach and multilayer repair of skull base defect in the LRS.


METHODS
Recurrence, graft techniques, postoperative intracranial pressure (ICP), and use of ventriculoperitoneal (VP) shunt.


RESULTS
Thirteen CSF leaks originating in the LRS were surgically repaired in 11 patients; 2 patients required bilateral leak repair. The endoscopic transpterygoid approach was used in 12 of 13 repairs. Eight patients had failed attempts at repair prior to presentation (4 endoscopic sphenoidotomies and 4 middle cranial fossa [MCF] approaches). One patient presented with a temporal lobe abscess following hydroxyapatite "obliteration" to seal off the LRS. This required a combined MCF/transpterygoid approach to drain the abscess, remove the encephalocele and hydroxyapatite, and seal the skull base defect. In 2 cases, the LRS was left patent owing to concerns of inadequate mucosal extirpation. The median duration of follow-up was 10.8 months (range, 2-29 months). One patient experienced a failure (2 months after repair), which was successfully sealed on the second attempt. Postoperatively, 5 patients required VP shunts, and 5 were maintained on acetazolamide for elevated ICP (average, 26.7 cm H₂O in 8 patients; presumed elevated in 2 patients).


CONCLUSIONS
The current study demonstrated a 92% success rate using the endoscopic transpterygoid approach for LRS skull base defects providing support for routine use in the treatment algorithm. Poor outcomes were observed with previous surgical attempts to obstruct the LRS without repairing the skull base defect.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.
Nathan S
NS
Alexander
Mohamad R
MR
Chaaban
Kristen O
KO
Riley
Bradford A
BA
Woodworth
D000328:Adult; D000368:Aged; D000465:Algorithms; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome