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

Published online by Cambridge University Press:  02 September 2014

G Fyrmpas ,
I Konstantinidis ,
P Selviaridis  and
J Constantinidis
G Fyrmpas
Affiliation:
2nd Department of Otorhinolaryngology Head and Neck Surgery, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
I Konstantinidis
Affiliation:
2nd Department of Otorhinolaryngology Head and Neck Surgery, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
P Selviaridis
Affiliation:
1st Department of Neurosurgery, AHEPA University Hospital, Thessaloniki, Greece
J Constantinidis*
Affiliation:
2nd Department of Otorhinolaryngology Head and Neck Surgery, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
*
Address for correspondence: Prof Jannis Constantinidis, 2nd Department of Otolaryngology Head and Neck Surgery, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki Ring Road, 56429 Nea Efkarpia, Greece Fax: 00302310460802 E-mail: janconst@otenet.gr
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Abstract

Background:

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.

Keywords

Cerebrospinal Fluid RhinorrheaCerebrospinal Fluid LeakSphenoid SinusCerebrospinal Fluid PressureIntracranial HypertensionSurgery

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 9 , September 2014 , pp. 797 - 802
Copyright
Copyright © JLO (1984) Limited 2014 

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