Professor UCLA Head and Neck Surgery Los Angeles, CA, United States
Disclosure(s):
Marilene B. Wang, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Spontaneous cerebrospinal (CSF) leaks may occur following barotrauma in otherwise healthy adults with normal BMI. CSF leaks in the lateral sphenoid sinus are challenging to repair because of potential difficulty in identifying and accessing the site of leak. This video will demonstrate endoscopic repair of a spontaneous CSF leak which occurred in the lateral sphenoid sinus roof following an airplane flight. The patient was a 54 year-old previously healthy male with a normal BMI who experienced clear fluid drainage from the left nostril following an international airplane flight 4 weeks prior. CT imaging demonstrated opacification of the left sphenoid sinus with layered fluid and a possible defect in the roof of the lateral sphenoid sinus. MR imaging demonstrated communication of CSF from the middle cranial fossa with the left sphenoid sinus. Prior to surgery a lumbar drain was placed, and dilute fluorescein was injected. Surgery began with identification of the natural ostium of the sphenoid sinus. The sphenoid, ethmoid and maxillary sinuses were opened widely. The sphenoid sinus was further opened using the drill and the Kerrison punch to access the lateral recess. Fluorescein was visualized in the lateral sphenoid recess. The bony septa surrounding the lateral recess were drilled down. Bleeding branches from the sphenopalatine and pterygoid branches of the internal maxillary artery were cauterized. The mucosa was stripped off the walls of the lateral recess, and the bony defect was identified in the medial roof, with arachnoid and fluorescein visualized. A fat graft was harvested and placed in the bony defect. A free mucosal graft was harvested from the right posterior septum and placed over the fat graft. Adherus Autospray Dural Sealant (Stryker, Inc., Kalamazoo, MI) was sprayed over the graft. Small pieces of Gelfoam (Pfizer, New York, NY) were placed over the graft, followed by Hemopore (Stryker, Inc., Kalamazoo, MI) packing. The patient did well postoperatively and had no further signs of CSF rhinorrhea.
