Management of spontaneous cerebrospinal fluid leaks of the sphenoid sinus: our experience

2014 ◽  
Vol 128 (9) ◽  
pp. 797-802 ◽  
Author(s):  
G Fyrmpas ◽  
I Konstantinidis ◽  
P Selviaridis ◽  
J Constantinidis
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Sphenoid Sinus ◽  
Successful Outcome ◽  
Dietary Advice ◽  
Elevated Intracranial Pressure ◽  
Endoscopic Closure ◽  
Cerebrospinal Fluid Leaks ◽  
Stable Reconstruction

AbstractBackground:Closure of spontaneous sphenoid sinus cerebrospinal fluid leaks can be challenging because of the relative inaccessibility of the lateral recess and the presence of intracranial hypertension. We present our experience of such cases and highlight factors associated with a successful outcome.Methods:Eleven patients with spontaneous, laboratory confirmed, sphenoid sinus cerebrospinal fluid leaks were included. All patients underwent endoscopic closure by either a three-layer technique or fat obliteration.Results:In all but one patient, the leak was successfully sealed (success rate, 90.9 per cent; mean follow up, 37.1 months). Elevated intracranial pressure was measured in eight patients, two of whom did not exhibit relevant clinical or radiological characteristics. Five patients received diuretics and dietary advice for weight reduction. In one patient with recurrence two weeks after repair, successful revision was performed by additional placement of a ventriculoperitoneal shunt (follow up, 67 months).Conclusion:Long-lasting cerebrospinal fluid fistula sealing in the sphenoid sinus requires stable reconstruction of the defect in three layers or fat obliteration if the anatomy is unfavourable. All patients should be intra- and post-operatively screened for elevated intracranial pressure to identify those who need additional intracranial pressure reduction measures.

Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

2017 ◽  
Vol 127 (9) ◽  
pp. 2011-2016 ◽  
Author(s):  
William Teachey ◽  
Jessica Grayson ◽  
Do-Yeon Cho ◽  
Kristen O. Riley ◽  
Bradford A. Woodworth
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Success Rate ◽  
Elevated Intracranial Pressure ◽  
Cerebrospinal Fluid Leaks

In reference to intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

2017 ◽  
Vol 128 (8) ◽  
pp. E271-E271 ◽  
Author(s):  
João Mangussi‐Gomes ◽  
Leonardo L. Balsalobre ◽  
Marcos Q. T. Gomes ◽  
Eduardo A. S. Vellutini ◽  
Aldo E. C. Stamm ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Success Rate ◽  
Elevated Intracranial Pressure ◽  
Cerebrospinal Fluid Leaks

Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge

2015 ◽  
Vol 129 (4) ◽  
pp. 358-364 ◽  
Author(s):  
G Martínez-Capoccioni ◽  
R Serramito-García ◽  
B Huertas-Pardo ◽  
A García-Allut ◽  
C Martín-Martín
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Patient Characteristics ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Recurrence Rates ◽  
Closure Rate ◽  
Cerebrospinal Fluid Leaks ◽  
Additional Therapy

AbstractObjective:This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy.Method:A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected.Results:Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy.Conclusion:Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

In response to in reference to intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

2018 ◽  
Vol 128 (8) ◽  
pp. E272-E272 ◽  
Author(s):  
William Teachey ◽  
Jessica Grayson ◽  
Do‐Yeon Cho ◽  
Bradford A. Woodworth ◽  
Kristen O. Riley
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Success Rate ◽  
Elevated Intracranial Pressure ◽  
Cerebrospinal Fluid Leaks

Markedly Elevated Intracranial Pressure Treated With Cranial Vault Expansion, Instead of CSF Shunting, in a Child With Hurler-Scheie Syndrome and Multiple Suture Craniosynostosis

2018 ◽  
Vol 56 (3) ◽  
pp. 395-399
Author(s):  
Jessica A. Ching ◽  
Jared S. Troy ◽  
Ernesto J. Ruas ◽  
Joshua M. Beckman ◽  
Gerald F. Tuite
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Cranial Vault ◽  
Elevated Intracranial Pressure ◽  
Treatment Alternative ◽  
Unique Case ◽  
Shunt Placement ◽  
Scheie Syndrome ◽  
Csf Shunting ◽  
Viable Treatment

Despite a known association of mucopolysaccharidoses (MPS) and craniosynostosis, treatment of elevated intracranial pressure (ICP) in these patients is primarily cerebrospinal fluid (CSF) shunting. We present a unique case of Hurler-Scheie syndrome with multisuture craniosynostosis and elevated ICP, without ventriculomegaly, where elevated ICP was successfully treated with extensive cranial vault expansion and shunt placement was avoided. Patients with MPS should be evaluated for craniosynostosis, and calvarial vault expansion may be considered as a viable treatment alternative to CSF shunting for elevated ICP in select patients.

scholarly journals Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

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.

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

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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