(A248) Transpterygoid Reconstructions of Lateral Sphenoid Recess Cerebrospinal Fluid Leaks with Pedicled Single-Layer Mucoperiosteal Flaps

Introduction: Cerebrospinal fluid (CSF) leaks in lateral sphenoid recess are rare clinical entities, and the endoscopic repair is challenging. We evaluated our surgical treatment and postoperative outcomes of lateral sphenoid recess CSF leaks via the transpterygoid reconstruction with a pedicled single-layered mucoperiosteal flap.

Methods: Study

Design: Retrospective study.
Setting: Department of Otolaryngology-Head and Neck Surgery.
Participants and

Methods: The medical records of patients with CSF leaks in lateral sphenoid recess were retrospectively reviewed.

Results: Thirty patients with an average body mass index of 27.1 kg/m2 were enrolled. Most lateral sphenoid recess CSF leaks are spontaneous cases (27 in 30 patients, 90%). Meningoencephalocele was identified in 21 patients (70%). 18 patients (60%) exhibited an empty sella turcica on radiological imaging. Six patients had undergone prior skull base reconstructions. For our surgical treatments, we achieved a success rate of 100% via the transpterygoid reconstructions, with the pedicled single-layered mucoperiosteal flap applied in 29 patients. No CSF leak reoccurred during the follow-up period (with an average time of 25.7 months). Three patients had an impermanent postoperative facial numbness. None of the patients required lumbar drainage placement. No prolonged nasal crusting, septal perforation, or other significant complications were observed.

Conclusions: A transpterygoid approach is imperative for treatment of spontaneous CSF leak in lateral sphenoid recess. Proper management of the graft bed facilitates survival of the pedicled flaps, promotes tissue healing and cicatrization. Reconstruction with the pedicled single-layered mucoperiosteal flap is effective and help reduce the possibility of free grafts associated complications.