Management Of Cerebrospinal Fluid Leakage In The Sphenoid Sinus With A Transpterygoid Endoscopic Approach

Introduction: Cerebrospinal fluid (CSF) leakage occurs when there is a direct communication between the subarachnoid space and the sinonasal mucosa, often due to trauma or iatrogenic injury. Accurate localization of the leakage site and differentiation from other nasal fluids are essential for appropriate management. This case report describes a sphenoid sinus CSF leak in a 65-year-old woman and discusses the efficacy of the transpterygoid endoscopic approach as a treatment option. Methods: A 65-year-old woman with 2-month clear rhinorrhea. HRCT result showed a left sphenoid sinus defect. Endoscopic transpterygoid surgery was performed, and reconstruction was done using abdominal fat and bone graft, with mucosa harvested from the middle turbinate. Results: Postoperative recovery proceeded without complications, with complete symptom resolution and no recurrence on follow-up. Conclusions: The transpterygoid endoscopic approach is a minimally invasive and effective treatment option for sphenoid sinus CSF leakage, offering high success with low morbidity compared to conventional transcranial techniques.