====== Leaks into sphenoid sinus ======

[[Leak]]s into [[sphenoid sinus]] (including post-[[transsphenoidal surgery]] leak).

1. LP BID or CLD: as long as pressure > 150mm H20 or CSF [[xanthochromia]]

a) if leak persists > 3 days: repack sphenoid sinus and pterygoid recesses with fat, muscle, cartilage
and/or fascia lata (must reconstruct floor of sella, packing alone is inadequate). Some recommend
against muscle since it putrefies and shrinks. Continue LP or CLD for 3–5 days post-op

b) if leak persists > 5 days: lumboperitoneal shunt (first R/O obstructive hydrocephalus)

2. more difficult surgical approach: intracranial (intradural) approach to medial aspect of [[middle
cranial fossa]]

3. consider transnasal sellar injection of [[fibrin glue]] under [[local anesthesia]]