Sternberg's Canal and the Controversies Surrounding it

Abstract

Introduction : Although Maxmillan Sternberg described this anatomical entity (the lateral craniopharyngeal canal or the Sternberg’s canal) as far back as in 1888, it has only recently stirred much controversy in world medical literature. Materials and methods : A review of contemporary world literature on this subject has been made and applied to the authors’ personal surgical experience of managing 21 spontaneous cerebrospinal fluid (CSF) leaks over a period of 6 years, with special focus on lateral sphenoid CSF leaks, in an attempt to understand their philosophy and clinical course. Results : Due to the rarity of such spontaneous CSF leaks (in all the published world series as well as the authors’ personal experience), it is difficult to comment on the exact site of congenital ‘weakness’, i.e. Sternberg’s canal. Similar body profiles of all the patients in most series further complicates the scenario. Conclusion : While one school of thought based on clinical and cadaveric studies hypothesizes, the Sternberg’s canal to be present lateral to the foramen rotundum, the other based entirely on radiological analysis of 1000 CT scans of the paranasal sinuses proposes it to be medial to the foramen rotundum. Most patients with lateral sphenoid sinus CSF leaks (in world literature as well as the authors’ personal experience), are obese middle-aged women irrespective of whether the leak arises medial or lateral to the foramen rotundum. Thus, two strong and valid theories as regards the origin and existence (in adult life) of the Sternberg’s canal are present and a multicentric, combined clinicoradiological, meta-analytical approach may probably serve as a solution to this controversy.