Melo Nelson Almeida d'Ávila, Borges Bruno Barros Pinto, Magliarelli Filho Pedro Augusto, Godoy Maria Dantas Costa Lima, Pereira Larissa Vilela, Pinna Fabio de Rezende, Voegels Richard Louis
Hospital Das Clínicas Da Universidade de São Paulo, São Paulo, Brazil,
Eur Arch Otorhinolaryngol. 2014 Sep;271(9):2587-94. doi: 10.1007/s00405-014-3049-8. Epub 2014 Apr 20.
The lateral recess of the sphenoid sinus is one of the most common sites of meningocele and spontaneous cerebrospinal fluid (CSF) leak. Despite the availability of several techniques for closure of skull base defects occurring in this location, recurrence still poses a major challenge. This report reviews the experience of surgical repair of lateral sphenoid sinus recess CSF leak at a tertiary referral center and provides a brief discussion of this rare lesion. Nine surgeries were performed for six cases of spontaneous lateral sphenoid sinus recess CSF leak (two revisions and one repair of a new defect). Two patients presented with intracranial hypertension (ICH) and four with meningocele or meningoencephalocele. The transpterygoid approach was used in two procedures. A multilayer graft was used in seven cases and a nasoseptal flap in two. Three patients received lumbar or ventricular shunts, and one received acetazolamide for ICH management. Two minor complications were recorded, and the overall surgical success rate was 78 %. We conclude that nasoseptal flaps are a valid option for repair of recurrent CSF leaks, particularly in the lateral sphenoid sinus recess. Furthermore, identification and correction of ICH plays an essential role in the success of treatment in this patient population.
蝶窦外侧隐窝是脑膜膨出和自发性脑脊液漏最常见的部位之一。尽管有多种技术可用于闭合该部位出现的颅底缺损，但复发仍然是一个重大挑战。本报告回顾了在一家三级转诊中心手术修复蝶窦外侧隐窝脑脊液漏的经验，并对这种罕见病变进行简要讨论。对6例自发性蝶窦外侧隐窝脑脊液漏患者进行了9次手术（2次翻修手术和1次新缺损修复手术）。2例患者出现颅内高压（ICH），4例出现脑膜膨出或脑膜脑膨出。2例手术采用经翼突入路。7例使用多层移植物，2例使用鼻中隔瓣。3例患者接受了腰段或脑室分流术，1例因颅内高压接受乙酰唑胺治疗。记录到2例轻微并发症，总体手术成功率为78%。我们得出结论，鼻中隔瓣是修复复发性脑脊液漏的有效选择，特别是在蝶窦外侧隐窝。此外，识别和纠正颅内高压在该患者群体的治疗成功中起着至关重要的作用。
