Concomitant Hidden Skull Base Defects in Patients with Sternberg Canal CSF Fistulas

Cem Meco; H. Basak; S. Beton; S. Mulazimoglu; B. Kucuk; I. Yorulmaz

doi:10.1055/s-0034-1383934

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

Concomitant Hidden Skull Base Defects in Patients with Sternberg Canal CSF Fistulas

Cem Meco ¹, H. Basak ², S. Beton ², S. Mulazimoglu ², B. Kucuk ², I. Yorulmaz ²

¹Ankara University and Salzburg Paracelsus University, Turkey
²Department of Otorhinolaryngology Head and Neck Surgery, Ankara University, Turkey

Abstract

Objective: The aim of the study was to identify concomitant hidden skull base defects in patients with a persistent lateral craniopharyngeal canal (Stenberg canal CSF fistula). Study Design: Retrospective analysis. Methods: We reviewed patients who were operated for a Sternbergs canal CSF fistula from 2007 to 2014 at Ankara University. In addition to imaging, all patients received preoperative intrathecal 5% sodium fluorescein. Endonasal endoscopic approach was used for repair, nearby a bilateral diagnostic endoscopy with fluorescein filter, performed to search for concomitant defects. Results: A total of five Sternberg canal CSF fistula patients were operated. Other than primary defects at expected locations on sphenoid sinus lateral walls, we identified a second hidden skull base defect as a small meningocele without CSF leakage in two patients. Both defects were around olfactory fibers, one located at the contralateral anterior and other at the ipsilateral posterior cribriform plate according to the side of primary defects. In all patients, watertight closure of all CSF fistulas and all identified skull base defects were achieved and no recurrences were observed in a mean follow-up time of 32 months. Conclusion: In our caseload patients who were diagnosed for a Sternberg canal CSF fistula had a second skull base defect with a high percentage. Surgeons should be aware of this fact and repair these as well, to entirely protect patients from the risk of ascending meningitis.