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Modified Transpterygoid Approach to Sphenoid Meningoencephaloceles: A Shorter Run for a Longer Slide.
- Source :
-
The Laryngoscope [Laryngoscope] 2021 Oct; Vol. 131 (10), pp. 2224-2230. Date of Electronic Publication: 2021 Jun 07. - Publication Year :
- 2021
-
Abstract
- Objectives: Cerebrospinal fluid (CSF) leaks and meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be challenging. The traditional transpterygoid approach through the pterygopalatine fossa (PPF) is time consuming and places important structures at risk, which can lead to significant morbidity. We report a multi-institutional experience using a simplified, endoscopic modified transpterygoid approach (MTPA), which spares the PPF contents in the management of lateral sphenoid sinus meningoencephaloceles and CSF leaks.<br />Study Design: Multi-Institutional, Retrospective Case Series.<br />Methods: Patients with lateral sphenoid recess CSF leaks and meningoencephaloceles between 2014 and 2020 who underwent the MTPA at two academic medical centers were identified. Repair techniques and outcomes were evaluated.<br />Results: Thirty-three patients underwent the MTPA for management. Skull base reconstruction was performed using a free mucosal graft (24/33, 72.7%), nasoseptal flap (4/33, 12.1%), bone grafts (3/33, 9.1%), and abdominal fat grafts (2/33, 6.1%). Lumbar drains and perioperative intracranial pressure measurements were routinely employed. Postoperative complications were uncommon and included three patients (9.7%) with temporary V2 anesthesia, one patient (3.2%) with prolonged V2 anesthesia, and one patient (3.2%) with subjective dry eye, all of which resolved at 9 months postoperatively. There were no recurrent CSF leaks resulting in a 100% success rate. Average follow-up was 13 months.<br />Conclusion: The MTPA reduces morbidity and greatly simplifies access to the lateral sphenoid sinus for the management of CSF leaks and meningoencephaloceles, without compromising exposure. This technique avoids the need for extensive PPF dissection and should be considered for the management of benign lesions involving the lateral sphenoid sinus.<br />Level of Evidence: 4 Laryngoscope, 131:2224-2230, 2021.<br /> (© 2021 The American Laryngological, Rhinological and Otological Society, Inc..)
- Subjects :
- Adult
Aged
Cerebrospinal Fluid Leak diagnosis
Cerebrospinal Fluid Leak etiology
Encephalocele complications
Encephalocele diagnosis
Encephalocele pathology
Female
Follow-Up Studies
Humans
Male
Meningocele complications
Meningocele diagnosis
Meningocele pathology
Middle Aged
Retrospective Studies
Sphenoid Bone diagnostic imaging
Sphenoid Sinus diagnostic imaging
Sphenoid Sinus pathology
Sphenoid Sinus surgery
Surgical Flaps transplantation
Tomography, X-Ray Computed
Treatment Outcome
Cerebrospinal Fluid Leak surgery
Encephalocele surgery
Endoscopy methods
Meningocele surgery
Sphenoid Bone surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1531-4995
- Volume :
- 131
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- The Laryngoscope
- Publication Type :
- Academic Journal
- Accession number :
- 34096616
- Full Text :
- https://doi.org/10.1002/lary.29672