title: A Unique Case of Bilateral Recurrent Sphenoid Sinus Cerebrospinal Fluid Leaks: Primary Acquired Leak Within the Lateral Sphenoid Sinus Recess, Followed by a Leak via Sternberg's Canal.
abstract: OBJECTIVE
  This case presents a previously undescribed clinical scenario of spontaneous cerebrospinal fluid (CSF) leaks secondary to a lateral sphenoid sinus recess skull base dehiscence and contralateral Sternberg's canal. This case report aims to characterize the presentation and successful management of these lesions.
  
  
  METHODS
  The electronic medical record was used to collect information pertaining to the patient's clinical history.
  
  
  RESULTS
  The patient was a middle-aged, obese female with persistent clear rhinorrhea as her only presenting symptom. Neuroradiologic studies localized the defect to the lateral sphenoid sinus recess. CSF opening pressures were within normal limits, but radiographic findings were consistent with elevated intracranial pressure. After an endoscopic transnasal transsphenoidal approach failed to resolve the CSF leak, a transpterygoid approach facilitated CSF leak resolution. The patient then did well for the following 2 years, but later developed a CSF leak through a contralateral Sternberg's canal. An endoscopic suprapterygoid procedure and ventriculoperitoneal shunt placement led to CSF leak resolution.
  
  
  CONCLUSIONS
  This case demonstrates one of the only published examples of a sphenoid sinus CSF leak secondary to Sternberg's canal as it was originally described in the literature. Wide endoscopic surgical exposure and intracranial pressure management ultimately led to CSF leak resolution.
authors: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Alexander P
authors: AP
authors: Marston
authors: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors: Jamie J
authors: JJ
authors: Van Gompel
authors: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Matthew L
authors: ML
authors: Carlson
authors: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA obrien.erin@mayo.edu.
authors: Erin K
authors: EK
authors: O'Brien
mesh_terms: D015170:Cerebrospinal Fluid Pressure; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009460:Neurologic Examination; D009765:Obesity / Q000150:complications; D019291:Skull Base / Q000000981:diagnostic imaging; D013101:Sphenoid Sinus / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: Sternberg’s canal; idiopathic intracranial hypertension; lateral sphenoid sinus recess; spontaneous cerebrospinal fluid leak; transpterygoid