Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-11T08:51:24.516Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Schuknecht, B, Simmen, D, Briner, HR, Holzmann, D. Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: imaging findings and correlation with endoscopic sinus surgery in 27 patients. AJNR Am J Neuroradiol 2008;29:542–9CrossRefGoogle ScholarPubMed
2Psaltis, AJ, Schlosser, RJ, Banks, CA, Yawn, J, Soler, ZM. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2012;147:196–203CrossRefGoogle ScholarPubMed
3Poletti-Muringaseril, SC, Rufibach, K, Ruef, C, Holzmann, D, Soyka, MB. Low meningitis-incidence in primary spontaneous compared to secondary cerebrospinal fluid rhinorrhoea. Rhinology 2012;50:73–9Google Scholar
4Bernal-Sprekelsen, M, Alobid, I, Mullol, J, Trobat, F, Tomas-Barberan, M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology 2005;43:277–81Google Scholar
5Wise, SK, Schlosser, RJ. Evaluation of spontaneous nasal cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg 2007;15:28–34Google Scholar
6Castelnuovo, P, Mauri, S, Locatelli, D, Emanuelli, E, Delu, G, Giulio, GD. Endoscopic repair of cerebrospinal fluid rhinorrhea: learning from our failures. Am J Rhinol 2001;15:333–42Google Scholar
7Gassner, HG, Ponikau, JU, Sherris, DA, Kern, EB. CSF rhinorrhea: 95 consecutive surgical cases with long term follow-up at the Mayo Clinic. Am J Rhinol 1999;13:439–47Google Scholar
8Wise, SK, Harvey, RJ, Neal, JG, Patel, SJ, Frankel, BM, Schlosser, RJ. Factors contributing to failure in endoscopic skull base defect repair. Am J Rhinol Allergy 2009;23:185–91Google Scholar
9Holzmann, D, Wild, C. Obesity as a risk factor for primary spontaneous rhinoliquorrhea. Arch Otolaryngol Head Neck Surg 2003;129:324–6Google Scholar
10Schlosser, RJ, Wilensky, EM, Grady, MS, Palmer, JN, Kennedy, DW, Bolger, WE. Cerebrospinal fluid pressure monitoring after repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2004;130:443–8Google Scholar
11Lindstrom, DR, Toohill, RJ, Loehrl, TA, Smith, TL. Management of cerebrospinal fluid rhinorrhea: the Medical College of Wisconsin experience. Laryngoscope 2004;114:969–74Google Scholar
12Mirza, S, Thaper, A, McClelland, L, Jones, NS. Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 years. Laryngoscope 2005;115:1774–7CrossRefGoogle ScholarPubMed
13Alexander, NS, Chaaban, MR, Riley, KO, Woodworth, BA. Treatment strategies for lateral sphenoid sinus recess cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2012;138:471–8Google ScholarPubMed
14Smith, JL. Whence pseudotumor cerebri? J Clin Neuroophthalmol 1985;5:55–6Google Scholar
15Hooper, AC. Sphenoidal defects—a possible cause of cerebrospinal fluid rhinorrhoea. J Neurol Neurosurg Psychiatry 1971;34:739–42CrossRefGoogle ScholarPubMed
16Schick, B, Draf, W, Kahle, G, Weber, R, Wallenfang, T. Occult malformations of the skull base. Arch Otolaryngol Head Neck Surg 1997;123:77–80CrossRefGoogle ScholarPubMed
17Barañano, CF, Cure, J, Palmer, JN, Woodworth, BA. Sternberg's canal: fact or fiction? Am J Rhinol Allergy 2009;23:167–71CrossRefGoogle ScholarPubMed
18Yew, M, Dubbs, B, Tong, O, Nager, GT, Niparko, JK, Tatlipinar, A et al. Arachnoid granulations of the temporal bone: a histologic study of dural and osseous penetration. Otol Neurotol 2011;32:602–9Google Scholar
19Gacek, RR, Gacek, MR, Tart, R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. Am J Otol 1999;20:770–6Google ScholarPubMed
20Prichard, CN, Isaacson, B, Oghalai, JS, Coker, NJ, Vrabec, JT. Adult spontaneous CSF otorrhea: correlation with radiographic empty sella. Otolaryngol Head Neck Surg 2006;134:767–71Google Scholar
21Shetty, PG, Shroff, MM, Fatterpekar, GM, Sahani, DV, Kirtane, MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol 2000;21:337–42Google Scholar
22Silver, RI, Moonis, G, Schlosser, RJ, Bolger, WE, Loevner, LA. Radiographic signs of elevated intracranial pressure in idiopathic cerebrospinal fluid leaks: a possible presentation of idiopathic intracranial hypertension. Am J Rhinol 2007;21:257–61Google Scholar
23Woodworth, BA, Prince, A, Chiu, AG, Cohen, NA, Schlosser, RJ, Bolger, WE et al. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg 2008;138:715–20Google Scholar
24Boulton, M, Armstrong, D, Flessner, M, Hay, J, Szalai, JP, Johnston, M. Raised intracranial pressure increases CSF drainage through arachnoid villi and extracranial lymphatics. Am J Physiol 1998;275:R889–96Google ScholarPubMed
25Schlosser, RJ, Wilensky, EM, Grady, MS, Bolger, WE. Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks. Am J Rhinol 2003;17:191–95CrossRefGoogle ScholarPubMed
26Wang, EW, Vandergrift, WA 3rd, Schlosser, RJ. Spontaneous CSF Leaks. Otolaryngol Clin North Am 2011;44:845–56, viiGoogle Scholar
27Schlosser, RJ, Woodworth, BA, Wilensky, EM, Grady, MS, Bolger, WE. Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol 2006;115:495–500CrossRefGoogle ScholarPubMed
28Giuseffi, V, Wall, M, Siegel, PZ, Rojas, PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology 1991;41:239–44CrossRefGoogle ScholarPubMed
29Johnson, LN, Krohel, GB, Madsen, RW, March, GA Jr.The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri). Ophthalmology 1998;105:2313–17Google Scholar
30Stangherlin, P, Ledeghen, S, Scordidis, V, Rubay, R. Benign intracranial hypertension with recurrent spontaneous cerebrospinal fluid rhinorrhoea treated by laparoscopic gastric banding [in French, Dutch]. Acta Chir Belg 2008;108:616–18CrossRefGoogle ScholarPubMed
31Sugerman, HJ, Felton, WL 3rd, Sismanis, A, Kellum, JM, DeMaria, EJ, Sugerman, EL. Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg 1999;229:634–40; discussion 640–2CrossRefGoogle ScholarPubMed
32Clark, D, Bullock, P, Hui, T, Firth, J. Benign intracranial hypertension: a cause of CSF rhinorrhoea. J Neurol Neurosurg Psychiatry 1994;57:847–49Google Scholar
33Goddard, JC, Meyer, T, Nguyen, S, Lambert, PR. New considerations in the cause of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol 2010;31:940–45Google Scholar
34Kari, E, Mattox, DE. Transtemporal management of temporal bone encephaloceles and CSF leaks: review of 56 consecutive patients. Acta Otolaryngol 2011;131:391–4Google Scholar
35Castelnuovo, P, Dallan, I, Pistochini, A, Battaglia, P, Locatelli, D, Bignami, M. Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks. Laryngoscope 2007;117:345–9Google Scholar
36Casiano, RR, Jassir, D. Endoscopic cerebrospinal fluid rhinorrhea repair: is a lumbar drain necessary? Otolaryngol Head Neck Surg 1999;121:745–50CrossRefGoogle ScholarPubMed
37Zweig, JL, Carrau, RL, Celin, SE, Schaitkin, BM, Pollice, PA, Snyderman, CH et al. Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: predictors of success. Otolaryngol Head Neck Surg 2000;123:195–201Google Scholar
38Lopatin, AS, Kapitanov, DN, Potapov, AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859–63Google Scholar
39Kirtane, MV, Lall, A, Chavan, K, Satwalekar, D. Endoscopic repair of lateral sphenoid recess cerebrospinal fluid leaks. Indian J Otolaryngol Head Neck Surg 2012;64:188–92CrossRefGoogle ScholarPubMed
40Cassano, M, Felippu, A. Endoscopic treatment of cerebrospinal fluid leaks with the use of lower turbinate grafts: a retrospective review of 125 cases. Rhinology 2009;47:362–8Google ScholarPubMed
41Tosun, F, Carrau, RL, Snyderman, CH, Kassam, A, Celin, S, Schaitkin, B. Endonasal endoscopic repair of cerebrospinal fluid leaks of the sphenoid sinus. Arch Otolaryngol Head Neck Surg 2003;129:576–80Google Scholar
42Seth, R, Rajasekaran, K 3rd, Luong, A, Benninger, MS, Batra, PS. Spontaneous CSF leaks: factors predictive of additional interventions. Laryngoscope 2010;120:2141–6Google Scholar
43Carrau, RL, Snyderman, CH, Kassam, AB. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope 2005;115:205–12CrossRefGoogle ScholarPubMed