title: Lateral sphenoid sinus recess cerebrospinal fluid leak: a case series.
abstract: 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.
authors.affiliation: Hospital Das Clínicas Da Universidade de São Paulo, São Paulo, Brazil, nelsondavila2000@gmail.com.
authors.forename: Nelson Almeida d'Ávila
authors.initials: NA
authors.lastname: Melo
authors.forename: Bruno Barros Pinto
authors.initials: BB
authors.lastname: Borges
authors.forename: Pedro Augusto
authors.initials: PA
authors.lastname: Magliarelli Filho
authors.forename: Maria Dantas Costa Lima
authors.initials: MD
authors.lastname: Godoy
authors.forename: Larissa Vilela
authors.initials: LV
authors.lastname: Pereira
authors.forename: Fabio de Rezende
authors.initials: Fde R
authors.lastname: Pinna
authors.forename: Richard Louis
authors.initials: RL
authors.lastname: Voegels
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D013100:Sphenoid Bone / Q000601:surgery*; D013101:Sphenoid Sinus; D014057:Tomography, X-Ray Computed
references.citation: Laryngoscope. 2004 Mar;114(3):528-32
references.pmid: 15091229
references.citation: Neurosurgery. 1995 Jan;36(1):202-6; discussion 206
references.pmid: 7708161
references.citation: Am J Otolaryngol. 2006 Nov-Dec;27(6):422-4
references.pmid: 17084229
references.citation: Curr Opin Otolaryngol Head Neck Surg. 2007 Feb;15(1):28-34
references.pmid: 17211180
references.citation: Laryngoscope. 2007 Sep;117(9):1560-9
references.pmid: 17597630
references.citation: Laryngoscope. 2006 Oct;116(10):1882-6
references.pmid: 17003708
references.citation: J Laryngol Otol. 1998 Aug;112(8):779-81
references.pmid: 9850324
references.citation: Am J Rhinol Allergy. 2009 Sep-Oct;23(5):518-21
references.pmid: 19807986
references.citation: Eur Arch Otorhinolaryngol. 2000;257(8):430-2
references.pmid: 11073192
references.citation: AJNR Am J Neuroradiol. 2000 Feb;21(2):337-42
references.pmid: 10696020
references.citation: Otolaryngol Head Neck Surg. 2005 Jul;133(1):20-6
references.pmid: 16025047
references.citation: Rhinology. 2009 Dec;47(4):369-74
references.pmid: 19936360
references.citation: Laryngoscope. 1991 Jan;101(1 Pt 1):56-64
references.pmid: 1984551
references.citation: Neurosurgery. 1998 May;42(5):1101-4; discussion 1104-5
references.pmid: 9588555