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Low incidence of true Sternberg’s canal defects among lateral sphenoid sinus encephaloceles

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Background

Spontaneous sphenoid sinus cerebrospinal fluid (CSF) encephaloceles have been postulated to arise from a persistent Sternberg’s canal. However, recent evidence has questioned this embryological etiology. We examined the anatomic location of a series of lateral sphenoid sinus encephaloceles to determine if they corresponded with the location of Sternberg’s canal.

Methods

We queried a prospectively acquired database of surgically treated spontaneous CSF leaks and identified those arising from the sphenoidal sinus. Images were reviewed to characterize the leaks with respect to the foramen rotundum (FR) and the vidian canal (VC). Four leak types were classified of which Type I (medial to FR and VC entering nasopharynx) was theoretically located in the precise location of Sternberg’s canal. Type II was medial to FR; Type III was lateral to FR; Type IV passed through an enlarged FR into sphenoid sinus. Demographic data were analyzed.

Results

Of 103 repaired CSF leaks, 17 arose from the lateral sphenoid sinus. There were no true Type I leaks, 3 Type II leaks, 12 Type III leaks, and 2 Type IV leaks. No differences were found with respect to sphenoid pneumatization, BMI, age, sex, arachnoid pits, or postoperative leak between different types.

Conclusions

No evidence was found to support the existence of a classic Sternberg canal CSF leak, supporting the hypothesis that most sphenoid spontaneous leaks likely occur secondary to chronically elevated ICP. Rare cases may be related to a weakness in the sphenoid wall in the region of Sternberg’s canal.

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Authors and Affiliations

  1. Departments of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA

    Samuel Z. Hanz, Leopold Arko IV, Franziska Schmidt & Theodore H. Schwartz

  2. Departments of Otolaryngology, Weill Cornell Medicine, New York Presbyterian, 525 East 68th St., Box #99, New York, NY, 10065, USA

    Ashutosh Kacker, Vijay K. Anand & Theodore H. Schwartz

  3. Departments of Radiology, Weill Cornell Medicine, New York Presbyterian, 525 East 68th St., Box #99, New York, NY, 10065, USA

    Apostolos J. Tsiouris

  4. Departments of Neuroscience, Weill Cornell Medicine, New York Presbyterian, 525 East 68th St., Box #99, New York, NY, 10065, USA

    Theodore H. Schwartz

Authors
  1. Samuel Z. Hanz
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  2. Leopold Arko IV
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  3. Franziska Schmidt
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  4. Ashutosh Kacker
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  6. Vijay K. Anand
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  7. Theodore H. Schwartz
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Correspondence to Theodore H. Schwartz.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was not needed due to IRB approval for retrospective review of endoscopic skull base patients.

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Hanz, S.Z., Arko, L., Schmidt, F. et al. Low incidence of true Sternberg’s canal defects among lateral sphenoid sinus encephaloceles. Acta Neurochir 162, 2413–2420 (2020). https://doi.org/10.1007/s00701-020-04329-2

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  • DOI: https://doi.org/10.1007/s00701-020-04329-2

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