Surgical Technique and Repair of Lateral Sphenoid Sinus Defects

Cerebral spinal fluid (CSF) leaks from lateral sphenoid sinus defects are rare and typically occur as a consequence of trauma, neoplasia or inflammatory causes, congenital variants (persistence of the Sternberg canal) and in patients with elevated intracranial pressure. With the evolution of endoscopic techniques, transpterygoid endoscopic repair has become popular. However, there is a steep learning curve to the procedure and even in the hands of experts, limitations remain. The middle cranial fossa approach for repair of lateral sphenoid sinus defects remains a viable option. We present our surgical technique and experience of 3 patients with atraumatic lateral sphenoid sinus CSF leaks that underwent successful multilayered repair of temporal lobe meningoencephaloceles via a middle cranial fossa approach.