Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus

Clinical article

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Object

Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare lesions that are hypothesized to result from persistence of the lateral craniopharyngeal canal. Prior reports of the management of this lesion have been limited by its relative rarity. The objective of this paper is to report the theoretical etiology, surgical technique, and outcomes in patients undergoing endoscopic repair of spontaneous meningoencephalocele of the sphenoid sinus.

Methods

The authors conducted a retrospective review of a multiinstitutional series of 13 cases involving patients who underwent endoscopic repair of spontaneous meningoencephalocele of the lateral sphenoid sinus. The surgical technique and pathophysiological considerations are discussed.

Results

The clinical manifestations included CSF rhinorrhea (85%), chronic headache (77%), and a history of meningitis (15%). The endoscopic approaches to the lateral sphenoid sinus were transnasal (39%), transpterygoid (23%), and transethmoid (39%). Two patients (8%) had postoperative CSF leaks, one of which closed spontaneously and one of which required revision endoscopic closure. All patients were free of leak at most recent follow-up. One patient experienced postoperative meningitis in the early postoperative period.

Conclusions

Endoscopic endonasal closure is an effective modality in the treatment of spontaneous meningoencephaloceles of the lateral sphenoid sinus. If the sphenoid sinus has extensive lateral pneumatization, adequate exposure may require a transpterygoid approach.

Abbreviations used in this paper: ICA = internal carotid artery; ICP = intracranial pressure.
Article Information

Contributor Notes

Address correspondence to: Abtin Tabaee, M.D., 10 Union Square East, Suite 4J, New York, New York 10003. email: atabaee@hotmail.com.Please include this information when citing this paper: published online August 21, 2009; DOI: 10.3171/2009.7.JNS0842.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Abiko SAoki HFudaba H: Intrasphenoidal encephalocele: report of a case. Neurosurgery 22:9339361988

  • 2

    Al-Nashar ISCarrau RLHerrera ASnyderman CH: Endoscopic transnasal transpterygopalatine fossa approach to the lateral recess of the sphenoid sinus. Laryngoscope 114:5285322004

    • Search Google Scholar
    • Export Citation
  • 3

    Bolger WE: Endoscopic transpterygoid approach to the lateral sphenoid recess: surgical approach and clinical experience. Otolaryngol Head Neck Surg 133:20262005

    • Search Google Scholar
    • Export Citation
  • 4

    Bowdler JD: Persistence of the so-called craniopharyngeal canal. J Anat 110:5091971

  • 5

    Carrau RLSnyderman CHKassam AB: The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope 115:2052122005

    • Search Google Scholar
    • Export Citation
  • 6

    Castelnuovo PDallan IPistochini ABattaglia PLocatelli DBignami M: Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks. Laryngoscope 117:3453492007

    • Search Google Scholar
    • Export Citation
  • 7

    Currarino GMaravilla KRSalyer KE: Transsphenoidal canal (large craniopharyngeal canal) and its pathologic implications. AJNR Am J Neuroradiol 6:39431985

    • Search Google Scholar
    • Export Citation
  • 8

    Hegazy HMCarrau RLSnyderman CHKassam AZweig J: Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope 110:116611722000

    • Search Google Scholar
    • Export Citation
  • 9

    Herman PSauvaget EGuichard JPTran Ba Huy P: Intrasphenoidal transsellar encephalocele repaired by endoscopic approach. Ann Otol Rhinol Laryngol 112:8908932003

    • Search Google Scholar
    • Export Citation
  • 10

    Kerr JTChu FWBayles SW: Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin North Am 38:5976112005

  • 11

    Lai SYKennedy DWBolger WE: Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus. Laryngoscope 112:180018052002

    • Search Google Scholar
    • Export Citation
  • 12

    Landreneau FEMickey BCoimbra C: Surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus. Neurosurgery 42:110111041998

    • Search Google Scholar
    • Export Citation
  • 13

    Leng LZBrown SAnand VKSchwartz TH: “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 62:2 SupplONSE342ONSE3432008

    • Search Google Scholar
    • Export Citation
  • 14

    Lowman RMRobinson FMcAllister WB: The craniopharyngeal canal. Acta Radiol Diagn (Stockh) 5:41541966

  • 15

    Maira GAnile CMangiola A: Primary empty sella syndrome in a series of 142 patients. J Neurosurg 103:8318362005

  • 16

    Mehendale NHMarple BFNussenbaum B: Management of sphenoid sinus cerebrospinal fluid rhinorrhea: making use of an extended approach to the sphenoid sinus. Otolaryngol Head Neck Surg 126:1471532002

    • Search Google Scholar
    • Export Citation
  • 17

    Morley TPWortzman G: The importance of the lateral extensions of the sphenoid sinus in post-traumatic cerebrospinal rhinorrhea and meningitis. J Neurosurg 22:3263321965

    • Search Google Scholar
    • Export Citation
  • 18

    Placantonakis DGTabaee AAnand VKHiltzik DSchwartz TH: Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery 61:3 Suppl1611662007

    • Search Google Scholar
    • Export Citation
  • 19

    Ricciardelli EJ: Embryology and anatomy of the cranial base. Clin Plast Surg 22:3613721995

  • 20

    Schick BBrors DPrescher A: Sternberg's canal—cause of congenital sphenoidal meningocele. Eur Arch Otorhinolaryngol 257:4304322000

    • Search Google Scholar
    • Export Citation
  • 21

    Schwartz THFraser JFBrown STabaee AKacker AAnand VK: Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 62:99110022008

    • Search Google Scholar
    • Export Citation
  • 22

    Spaziante Rde Divitiis EStella LCappabianca PGenovese L: The empty sella. Surg Neurol 16:4184261981

  • 23

    Sternberg M: Ein bisher noch nicht beschriebener Kanal im Keilbein des Menschen. Anat Anz 3:7847851888

  • 24

    Tabaee APlacantonakis DGSchwartz THAnand VK: Intrathecal fluorescein in endoscopic skull base surgery. Otolaryngol Head Neck Surg 137:3163202007

    • Search Google Scholar
    • Export Citation
  • 25

    Tami TA: Surgical management of lesions of the sphenoid lateral recess. Am J Rhinol 20:4124162006

  • 26

    Tsutsumi KAsano TShigeno TMatsui TIto SKaizu H: Transcranial approach for transsphenoidal encephalocele: report of two cases. Surg Neurol 51:2522571999

    • Search Google Scholar
    • Export Citation
  • 27

    Van Alyea OE: Sphenoid sinus. Anatomic study, with consideration of the clinical significance of the structural characteristics of the sphenoid sinus. Arch Otolaryngol 34:2252531941

    • Search Google Scholar
    • Export Citation
  • 28

    Van Nouhuys JMBruyn GW: Nasopharyngeal transsphenoidal encephalocele, craterlike hole in the optic disc and agenesis of the corpus callosum. Pneumoencephalographic visualization in a case. Psychiatr Neurol Neurochir 67:2432581964

    • Search Google Scholar
    • Export Citation
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