A CASE REPORT: SURGICAL MANAGEMENT OF CEREBROSPINAL FLUID RHINORRHOEA FROM STERNBERG’S CANAL

Abstract

Cerebrospinal fluid (CSF) rhinorrhoea occurs due to breakdown of the structure that separates the airways from the subarachnoid space. Most cases of CSF leak will recover with surgical treatment. The current case of refractory nasal CSF leakage was able to be closed by endoscopic intranasal repositioning. The patient presented with recurrent CSF rhinorrhoea after endoscopic surgery. He exhibited watery rhinorrhoea. In nasal endoscopic findings, a clear watery nasal discharge was found, but the fistula site could not be identified. Sternberg’s canal was presumed as the site of the fistula by CT scans. Endoscopic intranasal repositioning was performed again, and the patient has since recovered without recurrence.

Treatment of CSF leakage requires accurate identification of the fistula, and it is necessary to keep the fistula site under clear vision with a secure surgical approach, as much as possible. After the endoscopic modified medial maxillectomy approach, the medial wall of the maxillary sinus was opened widely with preservation of the nasolacrimal duct. Additionally, the pterygopalatine fossa approach was used. Therefore, a good surgical site to reach the fistula outside the sphenoid bone was secured. The patient had no further symptoms of nasolacrimal duct, and had a good postoperative course.