A conservative surgical strategy for spontaneous cerebrospinal fluid leakage: a rare case report | [Rawal Medical Journal • 2023]

Author(s):

1. Yong Wan Kim: Department of Otorhinolaryngology-Head & Neck Surgery, Inje University Haeundae Paik Hospital,Busan,Republic of Korea

Abstract:

A 59-year-old male with no history of trauma or surgery presented with clear rhinorrhea occurring when he bent his head forward. A CT scan revealed localized fluid accumulation and a lateral wall defect involving the left sphenoid sinus. Using the transpterygoid approach, we widened the anterior wall of the sphenoid sinus inferolaterally to expose the lesion as much as possible. Reconstruction involved placing an interposition graft between the dura and the bony defect using the underlay technique, followed by free mucosal grafting. Histopathological examination revealed neuroglial cells, confirming the diagnosis of spontaneous cerebrospinal fluid rhinorrhea due to a meningoencephalocele.

Page(s): 1075-1078

DOI: DOI not available

Published: Journal: Rawal Medical Journal, Volume: 48, Issue: 4, Year: 2023

Keywords:

Endoscopy , Surgery , Cerebrospinal fluid leakage , rhinorrhea , nasal mucosa

References:

[1] Tabaee A,Anand VK,Cappabianca P,Stamm A,Esposito F,Schwartz TH .2010 .Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus. J Neurosurg, 112 : 1070-7.

[2] Bolger WE .2005 .Endoscopic transpterygoid approach to the lateral sphenoid recess: surgical approach and clinical experience. Otolaryngol Head Neck Surg, 133 : 20-6.

[3] Michael AP,Elbuluk O,Tsiouris AJ .2021 .The critical importance of a vascularized flap in preventing recurrence after endoscopic repair of spontaneous cerebrospinal fluid leaks and meningoencephaloceles. J Neurosurg, 137 : 79-86.

[4] Prescher BSDBA .2000 .Sternberg's canal - cause of congenital sphenoidal meningocele. Eur Arch Otorhinolaryngol, 257 : 430-2.

[5] Li M,Mao S,Tang R .2019 .Delayed Diagnosis and Treatment of Cerebrospinal Fluid Leakage in Current Practice. J Craniofac Surg, 30 : 1657-61.

[6] Quatre R,Attye A,Righini CA .2017 .Spontaneous Cerebrospinal Fluid Rhinorrhea: Association with Body Weight and Imaging Data. J Neurol Surg B Skull Base, 78 : 419-24.

[7] Kasemsiri P,Solares CA,Carrau RL .2013 .Endoscopic endonasal transpterygoid approaches: anatomical landmarks for planning the surgical corridor. Laryngoscope, 123 : 811-5.

[8] Ulu MO,Aydin S,Kayhan A .2018 .Surgical Management of Sphenoid Sinus Lateral Recess Cerebrospinal Fluid Leaks: A Single Neurosurgical Center Analysis of Endoscopic Endonasal Minimal Transpterygoid Approach. World Neurosurg, 118 : e473-e482.

[9] Sreenath SB,Tang DM,Ting JY .2021 .Modified Transpterygoid Approach to Sphenoid Meningoencephaloceles: A Shorter Run for a Longer Slide. Laryngoscope, 131 : 2224-30.

[10] Bozkurt G,Turri-Zanoni M,Coden E.,Endoscopic E. .2020 .Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects. J Neurol Surg B Skull Base, 81 : 553-561.

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