Division of General ORL, Head and Neck Surgery, Medical University Graz, Graz, Austria.
Rhinology. 2009 Dec;47(4):369-74. doi: 10.4193/Rhin08.236.
Cerebrospinal fluid (CSF) leaks and meningoencephaloceles of the lateral recess of sphenoid sinuses are rare findings. A congenital bony defect in the lateral wall of sphenoid sinus called Sternberg's canal could be the origin of these lesions. Their endoscopic transnasal management is challenging though less traumatic than transcranial approaches. The aim of this study was to define Sternberg's canal as a potential source for these rare lesions and to describe their endoscopic endonasal management.
In a retrospective analysis clinical charts of 27 patients with CSF-leaks and / or meningoencephaloceles operated between March 2002 and October 2008 at the University ENT-hospital Graz have been reviewed. All patients were treated by an endoscopic endonasal approach.
Five patients (4 female / 1 male) were identified with spontaneous CSF-leaks from sphenoid sinus and meningoencephaloceles. In all five cases, Sternberg's canal was the site of leakage, with the bony and dural defects always located laterally between the maxillary and Vidian nerves. Mean age was 51.2 years and mean body mass index (BMI) was 31.9 kg/m2. All patients were operated using a multilayer closure technique. Two patients had recurrences after 12 days and 7 months, respectively, managed by endoscopic revision surgery resulting in a 100% closure rate after one revision (mean follow-up: 6.5 months).
Persisting Sternberg's canal can be the source of spontaneous CSF-leaks and meningoencephaloceles in the lateral recess of sphenoid sinus especially when associated with extensive pneumatisation. Endoscopic management is technically challenging, nevertheless its advantages are a good view of the surgical field while being less traumatic than transcranial approaches.
脑脊膜液（CSF）渗漏和蝶窦侧隐窝的脑膜脑膨出是罕见的发现。蝶窦外侧壁的先天性骨缺损，即 Sternberg 管，可能是这些病变的起源。尽管经颅入路创伤较大，但经鼻内镜处理这些病变具有一定的挑战性。本研究旨在将 Sternberg 管定义为这些罕见病变的潜在来源，并描述其经鼻内镜处理。
回顾性分析 2002 年 3 月至 2008 年 10 月在格拉茨大学耳鼻喉医院接受手术治疗的 27 例 CSF 漏和/或脑膜脑膨出患者的临床资料。所有患者均采用经鼻内镜入路治疗。
5 例（4 女/1 男）患者被诊断为蝶窦自发性 CSF 漏和脑膜脑膨出。在所有 5 例患者中，Sternberg 管是渗漏的部位，骨和硬脑膜缺损总是位于上颌神经和翼管神经之间的外侧。患者的平均年龄为 51.2 岁，平均体重指数（BMI）为 31.9kg/m2。所有患者均采用多层闭合技术进行手术。2 例患者分别在术后 12 天和 7 个月复发，经内镜修复手术治疗后，1 次修复后完全闭合率为 100%（平均随访时间：6.5 个月）。
持续存在的 Sternberg 管可能是蝶窦侧隐窝自发性 CSF 漏和脑膜脑膨出的来源，尤其是当与广泛的气房化相关时。内镜处理具有一定的技术挑战性，但与经颅入路相比，其优势在于可以清晰地观察手术视野，同时创伤较小。
