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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
  • 2 Downloads

Abstract

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.

Keywords

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

Notes

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.

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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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