Intrasphenoidal Encephalocele Associated with Cerebrospinal Fluid Fistula and Subdural Hematomas: Technical Case Report
ABSTRACT 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. 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. "
ABSTRACT: Transsphenoidal encephaloceles represent a rare clinical entity with wide range of symptoms in adult. Such lesions require accurate diagnosis and surgical treatment. The incidence of congenital encephalocele is very low occurring in approximately 1 in 3000-5000 live births. Even though 63 similar cases have been reported in the literature not all of them have been discussed completely. Due to the rare occurrence of these lesions, we will focus on the main clues in the diagnosis and management of such lesions, which are challenging. We intend to present our experience with two cases of trans-sphenoidal meningoencephalocels, one located medially and the other herniating through the Sternberg's canal. The younger was 17 and the elder was 47 years old and both of them presented with cerebrospinal fluid (CSF) leakage. Both patients were treated successfully using pure endoscopic endonasal approach. Ideal surgical approach for such patients is still not clear due to lack of adequate experience in the literature, it is suggested that full preoperative imaging studies might lead the surgeons to undertake minimally invasive skull base approaches in similar patients.Surgical Neurology International 01/2013; 4(1):5. DOI:10.4103/2152-7806.106260 · 1.18 Impact Factor
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- "The cerebral CT of our patient revealed the existence of 2 subdural hematomas. Among the 16 previously published cases of intrasphenoidal encephalocele, only one has been described with subdural hematoma  "
ABSTRACT: Intrasphenoidal meningoencephalocele is a rare clinical entity. Its origin can be congenital, traumatic, tumoral, or spontaneous. Presenting as cerebrospinal fluid fistula with rhinorrhea, the diagnosis and treatment of this uncommon disease is a real challenge for the otorhinolaryngologist. We report a case of sphenoidal meningocele treated using an endoscopic procedure and review the literature regarding its congenital origin.American Journal of Otolaryngology 11/2006; 27(6):422-4. DOI:10.1016/j.amjoto.2006.01.011 · 0.98 Impact Factor
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ABSTRACT: A 57-year old man was referred to our hospital with spontaneous cerebrospinal fluid (CSF) rhinorrhoea of 6 years duration. He had an episode of meningitis 2 months previously. CT cisternography and cranial MRI revealed a defect in the lateral wall of the sphenoid sinus, with an anteromedial temporosphenoidal encephalocele. Surgery was performed transcranially through a pterional approach. The temporal encephalocele was amputated, the sphenoid sinus obliterated and the dural defect repaired. Lumbar drainage was used for 5 days after surgery. Spontaneous CSF rhinorrhoea is only infrequently due to temporal encephalocele. Anteromedial temporosphenoidal encephaloceles are the least common type of temporal encephalocele, with only 12 reported in the literature.Journal of Clinical Neuroscience 10/2005; 12(7):827-9. DOI:10.1016/j.jocn.2004.09.030 · 1.38 Impact Factor