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      Spontaneous sphenoid sinus cerebrospinal fluid leak and meningoencephalocele – are they due to patent Sternberg's canal?

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          Abstract

          Sternberg's canal is a congenital bony defect in the lateral wall of the sphenoid sinus. If it persists to adulthood, it may become a source of spontaneous cerebrospinal fluid leak (CSF) and meningoencephalocele. The aim of the study was to describe the authors’ experience and review articles related to spontaneous sphenoid sinus CSF leaks and Sternberg's canal. We analysed patients managed surgicallly due to sphenoid sinus CSF leak and performed a PubMed database search. Two female patients with spontaneous CSF leak of sphenoid origin were found. Both patients underwent surgery with the endoscopic endonasal approach, and the defect was closed using the multi-layer technique. Twelve articles related to CSF leaks of sphenoid origin (due to Sternberg's canal) were found in the PubMed database. Lines of lesser resistance within sphenoid bone may underlie CSF leak pathology together with intracranial hypertension. The endoscopic transnasal approach to the sphenoid sinus is an excellent alternative to standard transcranial procedures.

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          Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension.

          Alice Grady, Bradford Woodworth, R. Schlößer … (2006)
          Previous reports indicate that elevated intracranial pressure (ICP) may cause spontaneous cerebrospinal fluid (CSF) leaks. In this study we examined the clinical diagnosis of benign intracranial hypertension (BIH) in this population using the modified Dandy criteria. We performed a retrospective review of clinical data and measurements of ICPs after surgical repair. Sixteen patients with spontaneous CSF leaks were surgically treated from 1996 to 2002. In 11 patients with CSF pressure measurements, strict adherence to the modified Dandy criteria definitively confirmed a diagnosis of BIH in 8 patients (72%) and a likely diagnosis in the 3 remaining patients. The mean ICP was 31.1 cm H20 (range, 17.3 to 52 cm H2O), and 81% of the patients were obese middle-aged women. Clinically, all patients had signs and/or symptoms of elevated ICP, such as headache (91%), pulsatile tinnitus (45%), hypertension (45%), balance problems (27%), and visual complaints (18%). Surgical repair was 100% successful in leak cessation over a mean follow-up of 14.1 months. Most patients with spontaneous CSF leaks fulfill the modified Dandy criteria; thus, this disorder appears to be a variant of BIH. Further investigation is needed to determine the exact cause of elevated CSF pressures in this group and whether medical or surgical treatments to correct the intracranial hypertension are warranted.
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            Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension.

            Malcolm Kennedy, Yahui Chiu, Bradford Woodworth … (2008)
            To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes. Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical follow-up. Fifty-six patients underwent repair of spontaneous CSF leaks. Eighty-two percent (46 of 56) were obese (average BMI 36.2 kg/m(2)). Nine patients had multiple CSF leaks. Fifty-four patients (96%) had associated encephaloceles. Fifty-three CSF leaks (95%) were successfully repaired at first attempt (34 months of follow-up). Intracranial pressures averaged 27 cm H(2)O. Patients were treated with acetazolamide or, in severe cases, with a ventriculoperitoneal shunt. Spontaneous CSF leaks have the highest recurrence rate of any etiology. With treatment of underlying intracranial hypertension coupled with endoscopic repair, the success rate (95%) approaches that of other etiologies of CSF leaks.
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              Non-traumatic cerebrospinal fluid rhinorrhoea.

              G Gesù, Tracey M. Baldwin, J PENNYBACKER … (1968)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Wideochir Inne Tech Maloinwazyjne
                Journal ID (iso-abbrev): Wideochir Inne Tech Maloinwazyjne
                Journal ID (publisher-id): WIITM
                Title: Videosurgery and other Miniinvasive Techniques
                Publisher: Termedia Publishing House
                ISSN (Print): 1895-4588
                ISSN (Electronic): 2299-0054
                Publication date (Electronic): 03 December 2014
                Publication date (Print): July 2015
                Volume: 10
                Issue: 2
                Pages: 347-358
                Affiliations
                Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
                Author notes
                Address for correspondence: Eliza Brożek-Mądry MD, PhD, Department of Otorhinolaryngology, Division of Dentistry, Medical University of Warsaw, 19/25 Stepinska St, 00-739 Warsaw, Poland. phone: +48 609 559 917. e-mail: elizabrozek@ 123456wp.pl
                Article
                Publisher ID: 24030
                DOI: 10.5114/wiitm.2014.47097
                PMC ID: 4520829
                PubMed ID: 26240642
                SO-VID: 6876443a-856c-4cdb-b1f6-365593ad39ef
                Copyright © Copyright © 2015 Sekcja Wideochirurgii TChP
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 May 2014
                Date revision received : 05 July 2014
                Date accepted : 01 September 2014
                Categories
                Subject: Case Report

                Keywords: sternberg's canal,spontaneous cerebrospinal fluid leak,endoscopic endonasal approach,multilayer dural repair,sphenoid sinus meningoencephalocele
                Data availability:
                Keywords: sternberg's canal, spontaneous cerebrospinal fluid leak, endoscopic endonasal approach, multilayer dural repair, sphenoid sinus meningoencephalocele

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