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

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...

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Detalles Bibliográficos
Autores principales: Rai, Survendra Kumar R., Dandpat, Saswat Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Thieme Medical and Scientific Publishers Private Ltd. 2020
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426184/
https://www.ncbi.nlm.nih.gov/pubmed/32801593
http://dx.doi.org/10.1055/s-0040-1713338
Descripción
Sumario: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.