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Lateral sphenoid sinus recess cerebrospinal fluid leak: a case series

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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.

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Authors and Affiliations

  1. Hospital Das Clínicas Da Universidade de São Paulo, São Paulo, Brazil

    Nelson Almeida d’Ávila Melo, Bruno Barros Pinto Borges, Pedro Augusto Magliarelli Filho, Maria Dantas Costa Lima Godoy, Larissa Vilela Pereira, Fabio de Rezende Pinna & Richard Louis Voegels

  2. Hospital Das Clínicas Da Universidade de São Paulo, Hospital Do Servidor Publico Estadual de São Paulo, São Paulo, Brazil

    Maria Dantas Costa Lima Godoy

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  1. Nelson Almeida d’Ávila Melo
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  2. Bruno Barros Pinto Borges
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  3. Pedro Augusto Magliarelli Filho
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  4. Maria Dantas Costa Lima Godoy
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  5. Larissa Vilela Pereira
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  6. Fabio de Rezende Pinna
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  7. Richard Louis Voegels
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Correspondence to Nelson Almeida d’Ávila Melo.

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Melo, N.A.d., Borges, B.B.P., Filho, P.A.M. et al. Lateral sphenoid sinus recess cerebrospinal fluid leak: a case series. Eur Arch Otorhinolaryngol 271, 2587–2594 (2014). https://doi.org/10.1007/s00405-014-3049-8

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  • DOI: https://doi.org/10.1007/s00405-014-3049-8

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