CSF leak post-anterior clinoidectomy: Case report and technical nuances

Abstract

Background: The anterior clinoid process represents the terminal portion of the lesser wing of the sphenoid bone and it is connected to the sphenoid bone by two rootes. Extradural anterior clinoidectomy is a crucial step in surgical access to lesions involving pathologies in sellar and parasellar regions. ACP pneumatization is common and must be evaluated radiologically before surgical intervention to avoid CSF leak. Case description: We report the case of an 11 years old girl presented with optic nerve lesion. The patient underwent craniotomy with anterior clinoidectomy for resection of optic nerve lesion en-block. Postoperatively, she suffered from CSF leak and post-operative CT scan showed an un-recognized anterior clinoid pneumatization. She was taken for endoscopic transphenoidal repair of leak and obliteration of the defect connecting between the intracranial space and the nasal cavity. Conclusion: ACP pneumatization can be recognized in all ages including pediatric age. CT scan is recommended before anterior clinoidectomy to assess the presence and extent of pneumatization to avoid CSF leak complications. When recognized, reconstruction must be attempted to obliterate the connection between the intracranial space and nasal sinuses. If CSF leak recognized post-operatively, repair is feasible through open or endoscopic transnasal approach. Keywords: ACP pneumatization, Anterior clinoidectomy, CSF leak