Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning
Abstract Objective Repair of cerebrospinal fluid (CSF) leaks of the lateral recess of the sphenoid (LRS) sinus can be challenging to accomplish via an endoscopic transphenoidal approach. The endoscopic transpterygoid approach can improve surgical access to the lateral recess but requires more extens...
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doaj-0a363997aa654ba191de3092a6c2a1fb2020-11-25T02:47:52ZengWileyLaryngoscope Investigative Otolaryngology2378-80382020-06-015337538010.1002/lio2.412Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planningAlice Z. Maxfield0Sarina K. Mueller1Aaishah R. Raquib2Ahmad R. Sedaghat3Regan W. Bergmark4Ralph B. Metson5Eric H. Holbrook6Benjamin S. Bleier7Stacey T. Gray8Department of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USADepartment of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USADepartment of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USADepartment of Otolaryngology, Head and Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio USADepartment of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USADepartment of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USADepartment of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USADepartment of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USADepartment of Otolaryngology—Head and Neck Surgery Harvard Medical School Boston Massachusetts USAAbstract Objective Repair of cerebrospinal fluid (CSF) leaks of the lateral recess of the sphenoid (LRS) sinus can be challenging to accomplish via an endoscopic transphenoidal approach. The endoscopic transpterygoid approach can improve surgical access to the lateral recess but requires more extensive surgical dissection. We review our experience with LRS CSF leak repair via both techniques to determine whether preoperative radiologic data can help predict the most appropriate surgical approach. Methods Electronic medical records of patients with LRS CSF leaks were retrospectively reviewed at a single tertiary referral center. Radiographic measurements from preoperative computed tomography images were reviewed. Results Twenty‐two LRS CSF leaks were identified. The transphenoidal and transpterygoid approach were used in 6 (27.3%) and 16 (72.7%) cases, respectively. The mean vidian canal to foramen rotundum angle of the repairs accessed transphenoidally as compared to the transptyergoid approach were not significantly different (41.93° ±10.91, 40.72° ±19.49, respectively; P = .63). However, the mean volume of the LRS accessed by the transpterygoid approach was significantly greater compared to those accessed through the transphenoidal approach (0.97 cm3 ± 0.48, 0.39 cm3 ± 0.40, respectively; P = .04). A LRS volume of 0.400 cm3 or greater predicted the use of the transpterygoid approach with 93.3% sensitivity and 60.0% specificity. Conclusion This study demonstrated that LRS CSF leaks that necessitated repair by the transpterygoid approach, rather than transphenoidal approach, were in the context of significantly larger lateral recess. Assessment of the LRS volume is a quantifiable parameter to aid in preoperative surgical planning. Level of Evidence Level 4.https://doi.org/10.1002/lio2.412cerebrospinal fluid leaklateral recess of sphenoidsphenoid cerebrospinal fluid leaktranspterygoid approach |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alice Z. Maxfield Sarina K. Mueller Aaishah R. Raquib Ahmad R. Sedaghat Regan W. Bergmark Ralph B. Metson Eric H. Holbrook Benjamin S. Bleier Stacey T. Gray |
spellingShingle |
Alice Z. Maxfield Sarina K. Mueller Aaishah R. Raquib Ahmad R. Sedaghat Regan W. Bergmark Ralph B. Metson Eric H. Holbrook Benjamin S. Bleier Stacey T. Gray Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning Laryngoscope Investigative Otolaryngology cerebrospinal fluid leak lateral recess of sphenoid sphenoid cerebrospinal fluid leak transpterygoid approach |
author_facet |
Alice Z. Maxfield Sarina K. Mueller Aaishah R. Raquib Ahmad R. Sedaghat Regan W. Bergmark Ralph B. Metson Eric H. Holbrook Benjamin S. Bleier Stacey T. Gray |
author_sort |
Alice Z. Maxfield |
title |
Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning |
title_short |
Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning |
title_full |
Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning |
title_fullStr |
Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning |
title_full_unstemmed |
Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning |
title_sort |
endoscopic management of lateral sphenoid cerebrospinal fluid leaks: identifying a radiographic parameter for surgical planning |
publisher |
Wiley |
series |
Laryngoscope Investigative Otolaryngology |
issn |
2378-8038 |
publishDate |
2020-06-01 |
description |
Abstract Objective Repair of cerebrospinal fluid (CSF) leaks of the lateral recess of the sphenoid (LRS) sinus can be challenging to accomplish via an endoscopic transphenoidal approach. The endoscopic transpterygoid approach can improve surgical access to the lateral recess but requires more extensive surgical dissection. We review our experience with LRS CSF leak repair via both techniques to determine whether preoperative radiologic data can help predict the most appropriate surgical approach. Methods Electronic medical records of patients with LRS CSF leaks were retrospectively reviewed at a single tertiary referral center. Radiographic measurements from preoperative computed tomography images were reviewed. Results Twenty‐two LRS CSF leaks were identified. The transphenoidal and transpterygoid approach were used in 6 (27.3%) and 16 (72.7%) cases, respectively. The mean vidian canal to foramen rotundum angle of the repairs accessed transphenoidally as compared to the transptyergoid approach were not significantly different (41.93° ±10.91, 40.72° ±19.49, respectively; P = .63). However, the mean volume of the LRS accessed by the transpterygoid approach was significantly greater compared to those accessed through the transphenoidal approach (0.97 cm3 ± 0.48, 0.39 cm3 ± 0.40, respectively; P = .04). A LRS volume of 0.400 cm3 or greater predicted the use of the transpterygoid approach with 93.3% sensitivity and 60.0% specificity. Conclusion This study demonstrated that LRS CSF leaks that necessitated repair by the transpterygoid approach, rather than transphenoidal approach, were in the context of significantly larger lateral recess. Assessment of the LRS volume is a quantifiable parameter to aid in preoperative surgical planning. Level of Evidence Level 4. |
topic |
cerebrospinal fluid leak lateral recess of sphenoid sphenoid cerebrospinal fluid leak transpterygoid approach |
url |
https://doi.org/10.1002/lio2.412 |
work_keys_str_mv |
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