Prelacrimal Recess-Pterygoid Window Approach to the Sphenoidal Lateral Recess Skull Base Defects

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Anatomy

Background:

• Cerebrospinal fluid leaks and meningoencephaloceles (CSFLME) in the sphenoidal lateral recess (SLR) present complex surgical challenges.
• Understanding the anatomical variations of the SLR, including pneumatization and surrounding neurovascular structures, is critical for successful treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of the prelacrimal recess-pterygoid window approach (PLR-PWA) for treating CSFLME in the SLR.
• To investigate the anatomical characteristics of the SLR, focusing on pneumatization and the course of the maxillary nerve (V2).

Main Methods:

• Retrospective review of 13 patients with spontaneous CSFLME in the SLR who underwent PLR-PWA.
• Classification of SLR pneumatization using Rhoton's classification and analysis of anatomical relationships via CT scans.

Main Results:

• The PLR-PWA achieved a 100% surgical success rate with a median follow-up of 26.8 months.
• 54.55% of patients experienced temporary post-operative hypoesthesia of the upper lip and face.
• All analyzed SLRs exhibited extensive pneumatization, with the V2 nerve coursing below and across the SLR in 23.08% of cases.

Conclusions:

• The PLR-PWA is a viable and minimally invasive surgical option for CSFLME in well-pneumatized or fully lateral type SLRs.
• Preoperative assessment of SLR pneumatization and the V2 nerve's anatomical course is essential for planning PLR-PWA procedures.