Optimizing Endoscopic Approaches for Sphenoid Lateral Recess Cerebrospinal Fluid Leaks: Proposal of a New Algorithm.

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cerebrospinal Fluid Dynamics

Background:

• Sphenoid lateral recess cerebrospinal fluid (CSF) leaks are a specific type of spontaneous leak, often associated with idiopathic intracranial hypertension.
• Current management lacks a structured algorithm tailored to these specific anatomical challenges.
• This study addresses the need for a systematic approach to surgical intervention.

Purpose of the Study:

• To propose and validate a comprehensive surgical management algorithm for sphenoid lateral recess CSF leaks.
• To correlate radiological defect classifications and anatomical parameters with surgical approach selection and outcomes.
• To optimize surgical strategies for improved patient outcomes and reduced complications.

Main Methods:

• An ambispective study integrating cadaveric dissections and clinical data from 33 patients (2017-2024).
• Utilized cadaveric models to assess the transcaruncular approach feasibility and V2-Vidian distance (VVD).
• Employed spiral CT scans for precise defect classification and analyzed radiological/intraoperative parameters, including VVD.

Main Results:

• Classified sphenoid lateral recess defects into four types (II, III, IV being most common).
• Mean VVD was 6.28 ± 1.9 mm; VVD < 4 mm correlated with increased neurovascular structure sacrifice.
• Achieved 100% surgical success with no CSF recurrence; complications included transient cheek paresthesia (12%).

Conclusions:

• The proposed algorithm, based on defect classification and VVD, effectively guides surgical approach selection for sphenoid lateral recess CSF leaks.
• Radiological assessment is crucial for tailoring surgical strategies and preserving critical neurovascular structures.
• This systematic approach enhances surgical outcomes and minimizes complications in managing these specific CSF leaks.