[Surgical treatment under endoscopic control of cerebrospinal fluid rhinorrhea of sphenoid origin. A propos of 5 cases].

From 5 to 15% of cerebrospinal fluid (CSF) leaks come from the sphenoid, subdivided in two groups: traumatic and spontaneous. Many surgical approaches are used for their treatment, with consistent morbidity. Five sphenoidal CSF leaks (3 traumatic and 2 spontaneous) were operated only by endoscopic endonasal route from 1993 to 1995, after endoscopic and computerized tomography (CT) scan evaluation. A sphenoidotomy by a simple endonasal route through the spheno-ethmoidal recess was performed in 3 cases. In the other 2 cases, the sphenoidotomy required a trans-ethmoidal approach through the posterior part of the ethmoid. After identification of the leak and the removal of mucosa, the sphenoid sinus was filled up by abdominal fat kept in place by biological glue and supported by a silastic sheat. No post-operative complication appeared. The median duration of hospitalization was 6.5 days (5-13). During the follow-up (19.5 months, 8-30), 4/5 complete remission was observed. The last case needed a second obturation at 11 months, due to a retraction of the fat, without recurrence. This endonasal endoscopic approach is safe and efficient for leaks closure, with no morbidity compared with others invasive approaches.