Intrasphenoidal Encephalocele Associated with Cerebrospinal Fluid Fistula and Subdural Hematomas: Technical Case Report

University of Rome Tor Vergata, Roma, Latium, Italy
Neurosurgery (Impact Factor: 3.62). 07/2003; 52(6):1487-90; discussion 1490. DOI: 10.1227/01.NEU.0000065183.05896.9C
Source: PubMed


Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported.
A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele.
A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure.
The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.

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    • "Incomplete fusion of the precursor of the greater wing of sphenoid, presphenoid and basi sphenoid can result a persistent channel termed the lateral craniopharyngeal canal of Sternberg.[412142328] When there is sufficient pneumatization of the sphenoid sinus, the lateral craniopharyngeal canal of Sternberg may act as the site of origin of congenital meningocele or CSF fistula. "
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