Comments on “Sternberg's Canal—A Rare Cause of Spontaneous Cerebrospinal Fluid Rhinorrhea”

Harrison M Thompson, Bradford A Woodworth 
 Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America

Correspondence Address:
Bradford A Woodworth
UAB - Department of Otolaryngology, FOT 1155,1720 2nd Avenue S, Birmingham, AL 35294-3412
United States of America

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Sir,

A recent article by Jayaprakash et al., “Sternberg's canal—A rare cause of spontaneous cerebrospinal fluid rhinorrhea”, presents a case of spontaneous cerebrospinal fluid (CSF) rhinorrhea that the authors determine to be linked to Sternberg's canal.[1] The association of lateral sphenoid recess CSF leaks to the persistence of this canal is an assertion that is inconsistent with the original description of this congenital canal.

The article states that the leak was determined to be in the inferolateral wall of the right sphenoid sinus. Sternberg originally described a congenital persistence secondary to failure of fusion of multiple sphenoid ossification centers which form a canal that runs entirely medial to the superior orbital fissure. For this reason, a CSF leak lateral to this landmark cannot be attributed to Sternberg's canal.[2] The vast majority of lateral sphenoid CSF leaks (as in the current case) occur lateral to the infraorbital nerve and foramen rotundum.

It is far more likely that there is another etiologic, non-congenital origin to lateral sphenoid recess leaks such as idiopathic intracranial hypertension (IIH). In 2014, Illing et al. showed that of 77 lateral recess of the sphenoid (LRS) CSF leaks, 96% were associated with radiographic findings of intracranial hypertension, such as empty sella and arachnoid pits, and 95% were associated with elevated opening pressure on lumbar drain or ventriculostomy pressure measurements.[3] The patient described in the article is a 37-year-old female, but no body mass index is mentioned. It is highly likely this patient has undiagnosed IIH that led to arachnoid pits in the lateral sphenoid roof and herniation of the brain through the defect. This patient should be followed long term and possibly see a neuroopthalmologist for evaluation.[4] She is more likely to have a recurrence since no pressure lowering measures were provided.[5]

We encourage the authors of the manuscript to read the original descriptions and treatise regarding Sternberg's canal. The mention of a “congenital” cause of LRS defects attributable to this canal should be eradicated from the literature.

Diclosures

Bradford A. Woodworth, MD is a consultant for Cook Medical, Baxter, and Smith and Nephew.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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