Repair of CSF leaks in the lateral recess of the sphenoid sinus transsphenoid vs. transpterygoid approach

Introduction: Cerebrospinal fluid (CSF) leaks involving the lateral extension of the sphenoid sinus create unique challenges for the endoscopic approach. Such defects are typically inaccessible through a typical transethmoid or transsphenoid corridor. Recently, an endoscopic transpterygoid approach to the lateral sphenoid recess has been adopted and reported by several groups. However, this technique requires extended surgical time and can put the sphenopalatine ganglion and maxillary division of the trigeminal nerve at risk. In the current study we detail our experience with an extended transnasal transsphenoidal approach to lateral sphenoid sinus CSF leaks and meningoencephaloceles. Methods: Retrospective review of medical records of patients treated with the transnasal transsphenoid or partial transpterygoid approach to the lateral sphenoid recess. Results: The transnasal transsphenoid approach was performed on 6 patients with either CSF leak or meningoencephalocele. The procedure was well tolerated with no significant complications. None of the repairs have required revision surgery. Conclusions: Access to the lateral recess of the sphenoid sinus can be difficult with standard endoscopic techniques. We have used both the transsphenoid and transpterygoid approaches to access CSF leaks in this region with similar results. In our experience, the transpterygoid approach can be avoided in most cases, resulting in reduced risks and morbidity to patients.