Complications Associated with a Transpterygoid Approach to Meningoencephalocele Repair

Background: Meningoencephaloceles within the lateral recess of the sphenoid sinus are uncommon. Moreover, data regarding the management and postoperative complications of these lesions are sparse as well. In this study, we describe endoscopic repair of lateral sphenoid meningoencephaloceles via a transpterygoid approach and report complications associated with this technique.

Methods: A retrospective review was conducted. Patients who underwent endoscopic repair via a transpterygoid approach from 2007–2011 were identified. Data collected included demographics, BMI, defect size, associated sinus pathology, and placement of a lumbar drain. Postoperative complications including V2 numbness, ocular dryness, CVA events, headaches, bleeding, sinusitis, seizures, metabolic disturbances, infection, sepsis, meningitis, brain abscess, meningoencephalocele recurrence, and death were also noted.

Results: Ten patients (7 women and 3 men) were treated for lateral sphenoid sinus encephaloceles over a 4-year period. The average age was 55. The average BMI was 35.3 Kg/m². CSF rhinorrhea was the most common presenting symptom (70%). Three patients (30%) presented with meningitis, one patient (1%) had headaches and orbital pain/pressure, one patient (1%) was asymptomatic, three patients (30%) had a right-sided encephalocele, and seven patients (70%) had a left-sided lesion. All patients had preoperative imaging. Six patients (60%) had a lumbar drain placed. In one of these patients, the lumbar drain malfunctioned and was replaced without complications. Defect size was reported in six patients. The average size of the defect was 0.97 cm. Neurological complications included postoperative intraparenchymal hemorrhage (1/10), seizure (1/10), hemipalatal hypesthesia (2/10), and headaches (5/10). Ocular complications were limited to dry eyes (5/10). Acetazolamide was used in eight patients, four of which developed electrolyte disturbances requiring cessation of treatment. None of the patients developed epistaxis postoperatively. There were no cases of sepsis, meningitis, or brain abscesses. One patient had a postoperative MI 26 days following the procedure and died. Endoscopy was the main tool used to evaluate recurrence in all patients during follow-up. The average duration of follow-up was 14 months. Meningoencephalocele and CSF leak repair was successful in 100% of cases.

Conclusion: Lateral sphenoid sinus meningoencephaloceles are rare and difficult to access endoscopically. The transpterygoid approach described in the present study represents a highly effective and low-morbidity/mortality technique to repair these lesions.