A rare case of cerebrospinal fluid rhinorrhea via Sternberg canal: a case report with endoscopic endonasal repair.

Introduction and importance: Cerebrospinal fluid (CSF) leaks and meningoencephaloceles involving the lateral recess of the sphenoid sinuses are rare often linked to Sternberg's canal - a congenital bony defect in the lateral wall of the sphenoid sinus. Case presentation: We report a case of a 45-year-old woman with spontaneous, left-sided CSF rhinorrhea without any history of trauma, surgery, or intracranial pathology. Radiological evaluation using CT and MRI revealed a meningoencephalocele and osteo-dural defect at the left lateral recess of the sphenoid sinus, consistent with a persistent Sternberg's canal. The patient underwent endoscopic endonasal transsphenoidal and trans-pterygoid repair, using a multilayered reconstruction technique involving fat, fascia lata, tissue glue, and inferior turbinate flap. Postoperative recovery was uneventful, and follow-up at 6 weeks confirmed complete resolution of CSF leakage, with no signs of recurrence on Valsalva maneuver or imaging. Clinical discussion: Accurate identification and endoscopic repair of such defects are technically challenging yet critical for successful outcomes. Conclusion: Though endoscopic repair of CSF leaks via Sternberg's canal presents technical challenges, it remains a safe, minimally invasive, and effective alternative to transcranial approaches, offering excellent visualization and favorable clinical outcomes.