Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg's canal

Abstract

This study provides objective evidence that LRS CSF leaks are secondary to erosions from intracranial hypertension and refutes the myth regarding a congenital origin from Sternberg's canal.

Endoscopic pedicled nasoseptal flap repair of spontaneous sphenoid sinus cerebrospinal fluid leaks

“…In our series, all patients were overweight and one was morbidly obese, consistent with BMI findings of other authors 5 18 20. Excess weight increases intra-abdominal and intrathoracic pressure and is suspected to impair circulation in cranial venous collectors potentiating permanent BIH 17 21 22.…”

“…Spontaneous CSF fistulae are associated with the highest rate of encephalocoele formation (50–100%) 5 20. In our series, 75% of defects occurred concurrently with encephalocoeles.…”

“…In our series, opening pressure remained within normal parameters in all cases and ranged from 8 to 15 cm H 2 O, as expected, in the setting of concurrent CSF leak. In contrast, Illing et al 20 reported an elevated ICP in 95% of their 59 patients with spontaneous CSF leaks of the lateral sphenoid recess (mean ICP 27.7±8.2 cm H 2 O). However, their data combined preoperative and postoperative measurements, which may account for the variation in their results from our own.…”

“…Excess weight increases intra-abdominal and intrathoracic pressure and is suspected to impair circulation in cranial venous collectors potentiating permanent BIH 17 21 22. Over time, constant pulsatile pressure applied to the skull base ultimately results in erosion, especially in regions of thin pneumatised bone such as that which occupies the lateral recess of the sphenoid 20. Quantification of ICP can be ascertained through measurement of opening pressure on lumbar puncture (normal 5–15 cm H 2 O),20 or through continuous monitoring via a lumbar drain in the postoperative period 5.…”

“…Over time, constant pulsatile pressure applied to the skull base ultimately results in erosion, especially in regions of thin pneumatised bone such as that which occupies the lateral recess of the sphenoid 20. Quantification of ICP can be ascertained through measurement of opening pressure on lumbar puncture (normal 5–15 cm H 2 O),20 or through continuous monitoring via a lumbar drain in the postoperative period 5. In our series, opening pressure remained within normal parameters in all cases and ranged from 8 to 15 cm H 2 O, as expected, in the setting of concurrent CSF leak.…”