1171 An Unusual Approach - Left Transorbital Approach to Repair of Lateral Sphenoid Wall CSF Leak Under Image Guidance

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Abstract Aim To present a case where transorbital and endonasal approaches were taken simultaneously to repair a cerebrospinal fluid (CSF) leak. Background The initial management plan for a sinus CSF leak is conservative management, as leakage stops within 1 week for 70% of patients suffering from a traumatic leak. However, in cases where the CSF leak does not heal spontaneously, surgical options must be explored as if left untreated patients run the risk of contracting meningitis. The most common approach taken is the endonasal approach whereby a septal flap is used to seal the leak. In cases where the location of the leak is difficult or impossible to reach endonasally, another approach can be considered such as a transorbital approach. In this case a 60-year-old lady presented with a CSF leak preceded by a recent episode of meningitis. She had a previous left sided CSF repair endonasally 4 years prior. Imaging revealed a meningo-encephalocoele from a left persistent sternbergs canal – After discussion in MDT a transorbital and endonasal approach was taken to repair the defect, with fat and fascia taken from her thigh. Conclusions A transorbital + endonasal approach is a safe, minimally invasive approach which can be used as an alternative to endonasal only approach in order to target and manipulate pathology within the skull base.

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