Transcranial extradural subtemporal repair for sphenoid sinus lateral recess meningoencephalocele: technical note

The authors demonstrate the use of an endovascular plug in securing a carotid artery pseudoaneurysm in an emergent setting requiring craniotomy for a concurrent subdural empyema.They describe the case of a 14-year-old boy with sinusitis and bifrontal subdural empyema who underwent transsphenoidal exploration at an outside hospital. An injury to the right cavernous segment of the ICA caused torrential epistaxis. Bleeding was successfully controlled by inflating a Foley balloon catheter within the sphenoid sinus, and the patient was transferred to the authors’ institution. Emergent angiography showed a dissection of the right cavernous carotid artery, with a large pseudoaneurysm projecting into the sphenoid sinus at the site of arterial injury. The right internal carotid artery was obliterated using pushable coils distally and an endovascular plug proximally. The endovascular plug enabled the authors to successfully exclude the pseudoaneurysm from the circulation. The patient subsequently underwent an emergent bifrontal craniotomy for evacuation of a left frontotemporal subdural empyema and exenteration of both frontal sinuses. He made a complete neurological recovery.Endovascular large-vessel sacrifice, obviating the need for numerous coils and antiplatelet therapy, has a role in the setting of selected acute neurosurgical emergencies necessitating craniotomy. The endovascular plug is a useful adjunct in such circumstances as the device can be deployed rapidly, safely, and effectively.

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Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

Neurosurgical FOCUS ◽

10.3171/2012.3.focus1267 ◽

2012 ◽

Vol 32 (6) ◽

pp. E5 ◽

Cited By ~ 30

Author(s):

Richard F. Schmidt ◽

Osamah J. Choudhry ◽

Joseph Raviv ◽

Soly Baredes ◽

Roy R. Casiano ◽

...

Keyword(s):

Skull Base ◽

Sphenoid Sinus ◽

Skull Base Surgery ◽

Surgical Anatomy ◽

Endoscopic Endonasal ◽

Csf Rhinorrhea ◽

Lateral Recess ◽

Sternberg Canal ◽

Deep Location ◽

Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

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Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1692639 ◽

2019 ◽

Vol 81 (05) ◽

pp. 553-561

Author(s):

Gülpembe Bozkurt ◽

Mario Turri-Zanoni ◽

Elisa Coden ◽

Federico Russo ◽

Hassan Ahmed Elhassan ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Dry Eye ◽

Sphenoid Sinus ◽

Cerebrospinal Fluid Leak ◽

Significant Morbidity ◽

Endoscopic Endonasal ◽

Lateral Recess ◽

Fluid Leak ◽

Extensive Surgery

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure.Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach.Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients.Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

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Management of Cerebrospinal Fluid Rhinorrhea in the Sphenoid Sinus Lateral Recess Through an Endoscopic Endonasal Transpterygoid Approach With Obliteration of the Lateral Recess

Ear Nose & Throat Journal ◽

10.1177/0145561320955140 ◽

2020 ◽

pp. 014556132095514

Author(s):

Chao He ◽

Hong-Tao Zhen

Keyword(s):

Cerebrospinal Fluid ◽

Sphenoid Sinus ◽

Surgical Repair ◽

Endoscopic Endonasal ◽

Simple Method ◽

Lateral Recess ◽

Cerebrospinal Fluid Rhinorrhea ◽

Surgical Access ◽

Skull Base Defect

Background: Cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess is a rare occurrence and poses unique challenges due to limited surgical access for surgical repair. Objective: To report our experience of surgical repair of cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess through an endoscopic endonasal transpterygoid approach with obliteration of the lateral recess. To evaluate the efficiency of this surgical procedure. Methods: A retrospective study. Twelve cases with cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess were reviewed. Assisted by image-guided navigation, cerebrospinal fluid rhinorrhea was repaired through an endoscopic endonasal transpterygoid approach, with obliteration of the lateral recess. Complications and recurrence were recorded. Medical photographs were used. Results: This surgical approach provided a relatively spacious corridor to dissect the sphenoid sinus lateral recess and do postoperative surveillance. The repair area completely healed in 3 months after surgery. Cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess was successfully repaired on the first attempt in all cases (100%). No main complications or recurrence was observed during a mean follow-up time of 40.3 months. Conclusion: The endoscopic endonasal transpterygoid approach gives appropriate access for the treatment of spontaneous cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess. Multilayer reconstruction of a skull base defect with obliteration of the lateral recess is a reliable and simple method.

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Pneumatization Patterns of the Petrous Apex and Lateral Sphenoid Recess

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1603972 ◽

2017 ◽

Vol 78 (06) ◽

pp. 441-446 ◽

Cited By ~ 2

Author(s):

Margherita Bruni ◽

Robert Wong ◽

Mark Tabor ◽

K. Boyev ◽

Alexander Malone

Keyword(s):

Sphenoid Sinus ◽

Normative Data ◽

Image Guidance ◽

Pearson Correlation ◽

Petrous Apex ◽

Lateral Recess ◽

Poor Access ◽

Level I ◽

Temporal Bones ◽

Future Work

Introduction The petrous apex poses a challenge for surgical intervention due to poor access. As intraoperative image guidance and surgical instrumentation improve, newer endoscopic approaches are increasingly favored. This study aims to provide normative data on the anatomy of the lateral sphenoid sinus recess and petrous apex. These normative data could assist in determining the efficacy of a transnasal transsphenoidal approach to lesions of the anteroinferior petrous apex. Methods This is a retrospective study investigating normative data on all maxillofacial computed tomography (CT) scans performed at a level I trauma center over a 6-month period. All appropriate images had the pneumatization pattern of the petrous apex and lateral recess of the sphenoid sinus reviewed by a single otologist and graded bilaterally. These were then analyzed in SPSS; Pearson correlation analyses and χ2 test were used. Results A total of 481 patients were identified, yielding a total of 962 temporal bones and sphenoid sinuses for analysis. Eighty-eight percent of sides analyzed had a nonpneumatized lateral recess. The petrous apex was nonpneumatized in 54% of sides analyzed. There was a correlation noted between the degree of pneumatization of the petrous apex and pneumatization of the lateral recess of the sphenoid. Conclusion This study is the first to provide normative data comparing pneumatization of the petrous apex and sphenoid sinus. These data may support future work evaluating the utility of an endonasal approach to the petrous apex.

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Minimally Invasive Lateral Paraorbital Approach for Repairing Lateral Recess of the Sphenoid Sinus Spinal Fluid Leak

World Neurosurgery ◽

10.1016/j.wneu.2020.08.202 ◽

2020 ◽

Vol 144 ◽

pp. 143-147

Author(s):

Andrew K. Wong ◽

Ricky H. Wong

Keyword(s):

Minimally Invasive ◽

Sphenoid Sinus ◽

Spinal Fluid ◽

Lateral Recess ◽

Fluid Leak

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Sphenoid Encephaloceles: Disease Management and Identification of Lesions Within the Lateral Recess of the Sphenoid Sinus

The Laryngoscope ◽

10.1097/00005537-200210000-00018 ◽

2002 ◽

Vol 112 (10) ◽

pp. 1800-1805 ◽

Cited By ~ 73

Author(s):

Stephen Y. Lai ◽

David W. Kennedy ◽

William E. Bolger

Keyword(s):

Disease Management ◽

Sphenoid Sinus ◽

Lateral Recess

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Lateral Transorbital versus Endonasal Transpterygoid Approach to the Lateral Recess of the Sphenoid Sinus: A Comparative Anatomical Study

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633461 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Joao Belo ◽

Huy Truong ◽

Joao Mangussi-Gomes ◽

Eric Wang ◽

Juan Fernandez-Miranda

Keyword(s):

Sphenoid Sinus ◽

Anatomical Study ◽

Lateral Recess

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Modified Ipsilateral Endonasal Endoscopic Trans-Sphenoidal Approach to Sphenoid Sinus Lateral Recess Cerebrospinal Fluid Leak Management in Two Cases: A Technical Note

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1713338 ◽

2020 ◽

Vol 11 (03) ◽

pp. 459-462 ◽

Cited By ~ 1

Author(s):

Survendra Kumar R. Rai ◽

Saswat Kumar Dandpat

Keyword(s):

Cerebrospinal Fluid ◽

Paranasal Sinus ◽

Sphenoid Sinus ◽

Middle Turbinate ◽

Fat Graft ◽

Csf Leak ◽

Invasive Technique ◽

Reconstructive Procedures ◽

Lateral Recess ◽

Autologous Fat Graft

Abstract Background Cerebrospinal fluid (CSF) leak from the sphenoid sinus lateral recess (SSLR) is very rare. Majority prefer transpterygoid approach which is extensive and time consuming. Two such cases were managed with least possible dissection/destruction of paranasal sinus. Methods Two cases of SSLR were accessed through the ipsilateral nostril from the side of CSF leak. Wide ipsilateral anterior sphenoidotomy was done preserving intersinus septum of sphenoid sinus. Middle turbinate was lateralized and remaining paranasal structures were preserved. Two handed single nostril approach was done in both the cases by 45- and 70-degree endoscope along with angled instruments. SSLR defects were visualized and packed with autologous fat graft and glue. Results SSLR defects could be visualized and packed with fat graft in both the cases from ipsilateral side. Both cases had uneventful outcome with no leak with mean follow-up of 11.5 months. Conclusion Modified ipsilateral endonasal endoscopy trans-sphenoidal approach is least invasive technique for SSLR leak. Use of angled scope and instruments help in defect visualization, avoiding extensive paranasal sinus dissection and bony removal. Tedious time-consuming reconstructive procedures can be avoided with simple fat graft with good outcome.

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