Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  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. 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):715–720

    Article  Google Scholar 

  3. Barañano CF, Cure J, Palmer JN, Woodworth BA (2009) Sternberg’s canal: fact or fiction? Am J Rhinol Allergy 23(2):167–171

    Article  Google Scholar 

  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):826–833

    Article  Google Scholar 

  5. Schlosser RJ, Bolger WE (2004) Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope 114(2):255–265

    Article  Google Scholar 

  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):7

    Google Scholar 

  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):705–711

    Article  CAS  Google Scholar 

  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):273

    Article  Google Scholar 

  9. Schlosser RJ, Bolger WE (2003) Significance of empty sella in cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 128(1):32–38

    Article  Google Scholar 

  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):311–315

    Article  CAS  Google Scholar 

  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):698–701

    Article  Google Scholar 

  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):626–632

    Article  Google Scholar 

  13. Meier JC, Bleier BS (2013) Novel techniques and the future of skull base reconstruction. Adv Otorhinolaryngol 74:174–183

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of ENT, JSS Medical College, Mysuru, Karnataka, India

    A. R. Babu, B. G. Prakash, D. Sandhya & Sreenivas Kamath

  2. Department of Neurosurgery, JSS Medical College, Mysuru, Karnataka, India

    Vinayaka I. Kadlimatti

Authors
  1. A. R. Babu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. G. Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vinayaka I. Kadlimatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Sandhya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sreenivas Kamath
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sreenivas Kamath.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Babu, A.R., Prakash, B.G., Kadlimatti, V.I. et al. Contrasting Surgical Management of CSF Leak from Lateral Recess of Sphenoid Sinus and Its Surgical Outcomes: Our Experience. Indian J Otolaryngol Head Neck Surg 71, 531–536 (2019). https://doi.org/10.1007/s12070-019-01715-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-019-01715-w

Keywords

Search

Navigation