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| NI FEATURE: THE FIRST IMPRESSION |
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| Year : 2023 | Volume
: 71
| Issue : 4 | Page : 643-644 |
Endoscopic Trans Pterygoid Approach for Managing Lateral Recess Cerebrospinal Fluid Leaks
Sanjeev Kumar
Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| Date of Submission | 07-Aug-2023 |
| Date of Decision | 07-Aug-2023 |
| Date of Acceptance | 07-Aug-2023 |
| Date of Web Publication | 18-Aug-2023 |
Correspondence Address:
Sanjeev Kumar
Department of Neurosurgery, DKS Post Graduate Institute and Research Center Raipur Chhattisgarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.383867
How to cite this article:
Kumar S. Endoscopic Trans Pterygoid Approach for Managing Lateral Recess Cerebrospinal Fluid Leaks. Neurol India 2023;71:643-4 |
The bony defects in the sphenoid sinus may be classified into four types according to their location. Type I defects are medial to the Vidian's canal, type II defects are located between the Vidian's canal and the foramen rotundum, type III defects are lateral to the foramen rotundum, and type IV are through the enlarged foramen rotundum. Excessive pneumatization of the pterygoid bone leading to the formation of the lateral recess and the raised intracranial pressure are prerequisites for developing an encephalocele and subsequent type III CSF leaks. While endoscopic management of type I and type II CSF leaks are straightforward, the type III and type IV defects require extended lateral exposure in the form of a trans-pterygoid approach.
This illustration intends to demonstrate the endoscopic surgical anatomy and a trans-pterygoid approach. The left middle turbinectomy, uncinectomy, wide middle meatal antrostomy, and the removal of the posterior wall of the maxillary sinus are essential to get this exposure. At times, this exposure requires sacrificing the sphenopalatine artery (SPA) and the Vidian's nerve (VN). The base of the pterygoid bone (PB) has been drilled off for the wide exposure of the sphenoid sinus lateral recess (LRSS). The contents of the pterygopalatine fossa may be retracted to gain further exposure. An encephalocele (E) with the CSF leak has been demonstrated lateral to the foramen rotundum. The contents of the encephalocele can be reduced, and the bony defect can be sealed off with the help of multilayered closure consisting of bone chips, fat, fascia, glue, and a mucosal flap.
Abbreviations used in the figure: M – Medial, L – Lateral, DPA – Descending Palatine Artery, E – Encephalocele, GPN – Greater Palatine Nerve, ICA – Internal Carotid Artery, ION – Infra-Orbital Nerve, IMA – Internal Maxillary Artery, LRSS – Lateral Recess Sphenoid Sinus, PB – Pterygoid Bone, PPG – Pterygopalatine Ganglia, PWMS – Posterior Wall of Maxillary Sinus, SS – Sphenoid Sinus, SPA – Sphenopalatine Artery, V2 – Maxillary Nerve, VN – Vidian's Nerve.
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