Endoscopic Transpterygoid Approach for Sternberg's Canal CSF Rhinorrhea

Objective: Sternberg's canal is a lateral craniopharyngeal canal remnant and a rare location of cerebrospinal fluid (CSF) rhinorrhea and encephalocele formation.

Methods: This study documented a patient whose CSF rhinorrhea was repaired through an endoscopic transpterygoid approach in our department. The informed consent form was obtained.

Results: She was a 73-year-old obese patient presented with unilateral right-sided clear rhinorrhea after falling prostrate six months ago. She denied headache, vision changes, balance disorder and a previous history of meningitis. Computed Tomography (CT) demonstrated a bony defect located in the right lateral sphenoid sinus wall medial to the foramen rotundum, compatible with a Sternberg's canal. No fracture line was detected. Maxillofacial Magnetic Resonance Imaging (MRI) proved the encephalocele protruding into the right sphenoid sinus and the dural discontinuity. B-2 transferrin testing confirmed the diagnosis. An endoscopic transpterygoid approach was performed. The middle turbinate was excised of which the mucoperiosteum and bone were separately served as grafts. The sphenopalatine artery and the Vidian nerve were preserved. Access to pterygopalatine fossa was granted by drilling the posterior maxillary sinus wall. A Hadad nasoseptal flap was prepared. The encephalocele was gently reduced by bipolar cautery and the defect was repaired with a multilayer closure consisting of overlapping mucoperiosteum and bone pate. The sphenoid sinus lateral wall coating was achieved by using the Hadad flap. Supplementary support was applied by Gelfoam and cellulose polymer dressings. None of the complications were experienced.

Conclusion: The endoscopic transpterygoid approach is recommended as a safe and adequate technique for Sternberg's canal CSF rhinorrhea.