Contrasting Surgical Management of CSF Leak from Lateral Recess of Sphenoid Sinus and Its Surgical Outcomes: Our Experience

  • A. R. Babu
  • B. G. Prakash
  • Vinayaka I. Kadlimatti
  • D. Sandhya
  • Sreenivas KamathEmail author
Original Article


CSF leak from Lateral Recess of Sphenoid (LRS) sinus accounts for 35% of all CSF rhinorrhoea cases. There are various surgical techniques described for repair of LRS CSF leak. This study describes the experience of LRS leak repair in a tertiary care center with three different surgical techniques. Study comprises of 3 cases of LRS CSF leak that presented to J.S.S. Hospital, during the time period of July 2018–January 2019, who underwent endoscopic CSF leak repair. All three cases underwent endoscopic endonasal transpterygoid approach to the leak site. The closure technique opted for all three cases were different. For the first case free mucosal flap from ipsilateral middle turbinate was used, for the second ipsilateral nasoseptal flap (NSF) was used and contralateral NSF was used for the third. All the cases were followed up for a minimum of 3 months. In all the 3 cases the CSF leak site was located in the lateral recess of Sphenoid sinus. Encephalocele was noted in two cases, which were cauterised and closure was done as planned. Crusting was more in cases that underwent closure using free mucosal flap. Healing and take up was similar for both the ipsilateral NSF and contralateral NSF. The endoscope has revolutionized the management of CSF leak from the lateral recess of sphenoid sinus. These defects can be managed efficiently using multilayer closure of defect. For large defects, the Posterior nasoseptal flaps can be used. In addition, contralateral PNSF has lower chances of being devascularized due to injury to pedicle while drilling the pterygoid plates.


CSF rhinorrhea CSF leak repair Lateral recess CSF leak Sternberg canal leak Endoscopic CSF leak repair Transnasal CSF leak repair 


Compliance with Ethical Standards

Conflict of interest

All the authors declare they have no conflicts of interest and have not received any funding.

Informed Consent

Written informed consent was obtained from all the individual participants in the study.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the institute.


  1. 1.
    Scott-Brown WG, Gleeson M, Browning GG (eds) (2008) Scott-Brown’s otolaryngology, head and neck surgery, 7th edn. Hodder Arnold, London (chapter number 129: cerebrospinal fluid rhinorrhea, pp. 1636–1642) Google Scholar
  2. 2.
    Woodworth BA, Prince A, Chiu AG, Cohen NA, Schlosser RJ, Bolger WE et al (2008) Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg 138(6):715–720CrossRefGoogle Scholar
  3. 3.
    Barañano CF, Cure J, Palmer JN, Woodworth BA (2009) Sternberg’s canal: fact or fiction? Am J Rhinol Allergy 23(2):167–171CrossRefGoogle Scholar
  4. 4.
    Banks CA, Palmer JN, Chiu AG, O’Malley BW, Woodworth BA, Kennedy DW (2009) Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg 140(6):826–833CrossRefGoogle Scholar
  5. 5.
    Schlosser RJ, Bolger WE (2004) Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope 114(2):255–265CrossRefGoogle Scholar
  6. 6.
    Mathias T, Levy J, Fatakia A, McCoul ED (2016) Contemporary approach to the diagnosis and management of cerebrospinal fluid rhinorrhea. Ochsner J 16(2):7Google Scholar
  7. 7.
    Wolf G, Anderhuber W, Kuhn F (1993) Development of the paranasal sinuses in children: implications for paranasal sinus surgery. Ann Otol Rhinol Laryngol 102(9):705–711CrossRefGoogle Scholar
  8. 8.
    Hiremath S, Gautam A, Sheeja K, Benjamin G (2018) Assessment of variations in sphenoid sinus pneumatization in Indian population: a multidetector computed tomography study. Indian J Radiol Imaging 28(3):273CrossRefGoogle Scholar
  9. 9.
    Schlosser RJ, Bolger WE (2003) Significance of empty sella in cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 128(1):32–38CrossRefGoogle Scholar
  10. 10.
    McCudden CR, Senior BA, Hainsworth S et al (2013) Evaluation of high resolution gel b(2)-transferrin for detection of cerebrospinal fluid leak. Clin Chem Lab Med 51(2):311–315CrossRefGoogle Scholar
  11. 11.
    Ecin G, Oner AY, Tokgoz N, Ucar M, Aykol S, Tali T (2013) T2-weighted vs. intrathecal contrast-enhanced MR cisternography in the evaluation of CSF rhinorrhea. Acta Radiol 54(6):698–701CrossRefGoogle Scholar
  12. 12.
    Seth R, Rajasekaran K, Benninger MS, Batra PS (2010) The utility of intrathecal fluorescein in cerebrospinal fluid leak repair. Otolaryngol Head Neck Surg 143(5):626–632CrossRefGoogle Scholar
  13. 13.
    Meier JC, Bleier BS (2013) Novel techniques and the future of skull base reconstruction. Adv Otorhinolaryngol 74:174–183PubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  • A. R. Babu
    • 1
  • B. G. Prakash
    • 1
  • Vinayaka I. Kadlimatti
    • 2
  • D. Sandhya
    • 1
  • Sreenivas Kamath
    • 1
    Email author
  1. 1.Department of ENTJSS Medical CollegeMysuruIndia
  2. 2.Department of NeurosurgeryJSS Medical CollegeMysuruIndia

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