Management of sphenoid lateral recess (SLR) cerebrospinal fluid (CSF) leaks present a challenge because of the location and requiring complete visualisation of the defect for a successful repair. Endoscopic endonasal transpterygoid approach (EETPA) is considered the gold standard in addressing these defects. We layout our experience in implementing this approach with plasma ablation.
A case series of 11 diagnosed patients of SLR CSF leaks who underwent plasma ablation assisted EETPA repair by a single surgeon between 2011 and 2020 at our institution. Outcomes in terms of surgical field grade on Wormald 11-point grading scale, post-operative complications, healing on nasal endoscopy and imaging and surgical success rate were assessed.
The etiology was spontaneous leak in 10 (90.9%) patients and secondary to temporal lobe abscess and/or meningitis in one (9.09%). Three (27%) patients were previously operated elsewhere by the transsphenoid route which we re-operated by this technique. As per Wormald grading, Grade 1 field in 3 (27.27%), Grade 2 in 6 (54.5%) and Grade 3 in 2 cases (18.18%) was noted. Complications occurred in 3 patients (27%) in the form of dry eye (9%), meningitis (9%) and transient CSF rhinorrhoea in immediate post-operative period (9%). Repair sites were well healed on follow up nasal endoscopy and imaging. Surgical success rate was 100%.
Plasma ablation assisted EETPA allows for uni-nostril approach to the SLR, provides easy accessibility and better visualisation with a bloodless field which allows appropriate repair thus minimising complications and preventing recurrence.