Endoscopic Treatment of Encephaloceles of the Lateral Wall of the Sphenoid Sinus

Abstract

Objective: The suitability of the endoscopic approach for the treatment of an encephalocele of the lateral wall of the sphenoid is discussed. This is a retrospective review of 4 cases diagnosed with temporosphenoidal encephalocele and having a history of CSF leak who were surgically treated using an endoscopic endonasal approach between January 2001 and June 2002 at the Department of Otolaryngology of Sant'Orsola-Malpighi University Hospital and the Department of Neurosurgery at Bellaria Hospital in Bologna.

Methods: Three patients were female between 48 and 73 years of age (mean: 61 years). All patients had suffered from a CSF leak for 5 months to 18 years. None of the patients had a past medical history of head trauma. A fourth patient had undergone a previous microscopic approach for a previously misdiagnosed CSF leak wrongly ascribed to an empty sella. Three patients underwent an ethmoid-pterygo-sphenoidal endoscopic approach (EPSEA), while the patient who had undergone previous microscopic surgery, was treated using a transnasal transsphenoidal endoscopic approach.

Results: The follow-up of the patients ranged from 10 to 26 months (mean: 18 months) and no case of a recurrent CSF leak was observed postoperatively.

Conclusions: In our report, the endoscopic approach was a useful tool for the treatment of encephaloceles of the lateral wall of the sphenoid sinus. In skilled hands, this technique permits both the resection of the encephalocele and the subsequent reconstruction of the defect also with a low rate of morbidity.

Sphenoid encephalocele - encephalocele - cerebrospinal fluid - endoscope

References

• 1 Noshes J M Van, Bruin G W. Nasopharyngeal transsphenoidal encephalocele: crater-like hole in the optic disk and agenesis of the corpus callosum-pneumoencephalographic visualization.  J Psycohol Neurol Neurochir. 1964;  67 243-258
• 2 Buchfelder M, Fahlbusch R, Huk W J, Thierauf P. Intrasphenoidal encephaloceles a clinical entity.  Acta Neurochir (Wien). 1987;  89 10-15 [Review]
• 3 Lai S Y, Kennedy D W, Bolger W E. Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus.  Laryngoscope. 2002;  112 1800-1805
• 4 Kaufman B, Nulsen F E, Weiss M H, Brodkey J S, White R J, Sykora G F. Acquired spontaneous, nontraumatic normal-pressure cerebrospinal fluid fistulas originating from the middle fossa.  Radiology. 1977;  122 379-387
• 5 Shetty P G, Shroff M M, Fatterpekar G M, Sahani D V, Kirtane M V. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings.  AJNR Am J Neuroradiol. 2000;  21 337-342
• 6 Schick B, Brors D, Prescher A. Sternberg's canal - cause of congenital sphenoidal meningocele.  Eur Arch Otorhinolaryngol. 2000;  257 430-432
• 7 Vergoni G, Antonelli V, Veronesi V, Servadei F. Spontaneous cerebrospinal fluid rhinorrhoea in anteromedial temporal occult encephalocele.  Br J Neurosurg. 2001;  15 156-158
• 8 Reynolds J M, Tomkinson A, Grigg R G, Perry C F. A Le Fort I osteotomy approach to lateral sphenoid sinus encephalocoeles.  J Laryngol Otol. 1998;  112 779-781
• 9 Clyde B L, Stechison M T. Repair of temporosphenoidal encephalocele with a vascularized split calvarial cranioplasty: technical case report.  Neurosurgery. 1995;  36 202-206; discussion 206 [Review]
• 10 Landreneau F E, Mickey B, Coimbra C. Surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus.  Neurosurgery. 1998;  42 1101-1104; discussion 1104 - 1105
• 11 Lanza D C, O'Brien D A, Kennedy D W. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles.  Laryngoscope. 1996;  106 1119-1125
• 12 Schlosser R J, Bolger W E. Management of multiple spontaneous nasal meningoencephaloceles.  Laryngoscope. 2002;  112 980-985
• 13 Bolger W E, Osenbach R. Endoscopic transpterygoid approach to the lateral sphenoid recess. ENT - Ear, Nose & Throat Journal 1999: 36-46
• 14 Alfieri A, Schettino R, Taborelli A, Pontiggia M, Reganati P, Ballarini V, Monolo L. Endoscopic endonasal treatment of a spontaneous temporosphenoidal encephalocele with a detachable silicone balloon. Case report.  J Neurosurg. 2002;  97 1212-1216
• 15 Leblanc R, Tampieri D, Robitaille Y, Olivier A, Andermann F, Sherwin A. Developmental anterobasal temporal encephalocele and temporal lobe epilepsy.  J Neurosurg. 1991;  74 933-939