Endonasal endoscopic repair of spontaneous cerebrospinal fluid rhinorrhea in the lateral recess of sphenoid sinus

Objective To investigate the clinical features, diagnosis and surgical treatment of spontaneous cerebrospinal fluid rhinorrhea (CSFR) in the lateral recess of sphenoid sinus. Methods and Results A retrospective analysis was conducted on the clinical data of 24 patients with spontaneous CSFR in the lateral recess of sphenoid sinus admitted to Beijing Tongren Hospital, Capital Medical University, between January 2019 and June 2023. Among them, there were 7 males and 17 females, with an average age of 46 years and an average body mass index (BMI) of 27.24 kg/m2. The average preoperative lumbar puncture (LP) cerebrospinal fluid (CSF) pressure was 200 mm H2O in 21 patients, with 11 patients exhibiting CSF pressure ≥ 200 mm H2O. Imaging studies revealed bone defects and meningoencephalocele herniation into the sphenoid sinus in all 24 patients. All patients underwent transnasal endoscopic repair surgery for CSFR. Specifically, 2 patients with preoperative CSF pressure ≥ 300 mm H2O underwent lumboperitoneal shunt (LPS) first, while the remaining 22 patients underwent endoscopic resection of meningoencephalocele in the lateral recess of sphenoid sinus via the pterygoid process approach, accompanied by skull base leak repair surgery. Two weeks postoperatively, the CSF pressure was reviewed in 21 patients, ranging from 140 to 320 mm H2O, with an average of 185 mm H2O. All patients were followed up for an average duration of 25.40 months. Subsequently, 3 patients with recurrent CSFR underwent LPS, and all 24 patients achieved clinical cure. Conclusions Spontaneous CSFR is related to chronic intracranial hypertension. Transnasal endoscopic leakage repair and CSF shunts are effective methods to treat this disease and prevent recurrence.