A Comparative Study of Two Reconstructive Methods to Repair Sternberg’s Canal Cerebrospinal Fluid Leaks

Objective: This study aimed to compare the effectiveness of a vascularized pedicle nasoseptal flap viz. Hadad– Bassagasteguy flap (HBF) with fat supplementation versus a free graft (fascia lata graft with fat) for repairing cerebrospinal fluid (CSF) leaks in the Sternberg’s canal using a transpterygoid transphenoidal approach. Methods: A retrospective study was performed on 32 patients with Sternberg’s Canal CSF Leak (SCCL) between May 2008 and March 2020. The diagnosis was established using Beta-2-transferrin and imaging—computed tomography cisternography and magnetic resonance imaging. Postoperative results were analyzed by symptom relief, and morbidity was assessed using a patient questionnaire and diagnostic nasal endoscopy. Results: This study included 32 patients (19 females and 13 males). Eighteen patients underwent repair with fat, fascia and 14 underwent closure with a nasoseptal flap and fat. The success rate was directly proportional to adequate visualization, exposure, and proper creation of the bed by extirpating all the mucosa in the lateral recess/sphenoid sinus, irrespective of the use of vascularized pedicle flaps. Conclusion: We found that the type of graft material HBF and fat or free grafts (fat with fascia) were both equally effective in closing the leak. However, postoperative morbidity was higher in cases where nasoseptal flaps were used for closure.