Cranial Repair of a Sternberg Canal Encephalocele Following Attempted Endoscopic Endonasal Repair Failure

Introduction: Sphenoidal encephaloceles can occur secondary to a patent Sternberg canal. Such encephaloceles have traditionally been treated by intracranial repair; however, advances in endoscopic techniques have led some to advocate an expanded endonasal endoscopic repair of sphenoidal encephaloceles. This case demonstrates a failure of endoscopic endonasal repair, which led to craniotomy.

Methods: We present a case report.

Results: A 32-year-old woman presented with headaches and persistent cerebrospinal fluid (CSF) rhinorrhea. Brain MRI showed a sphenoidal encephalocele. The patient underwent expanded endoscopic endonasal repair, including a layered dural closure with fascia lata. One month postoperatively, the patient experienced a return of CSF rhinorrhea. She underwent ventriculoperitoneal shunt placement and repeat endoscopic endonasal repair. Again, she experienced a return of CSF rhinorrhea, confirmed by myelogram. The patient subsequently underwent pterional craniotomy, which allowed for intracranial identification of the defect. The dura was primarily sutured, and the patent bony canal was filled with hydroxyapatite. The patient has had no further CSF rhinorrhea or headaches in 5 months of follow-up.

Conclusions: Treatment of underlying hydrocephalus is imperative in encephalocele repair. Sphenoidal encephaloceles may be difficult to repair with an expanded endonasal approach; thus, direct, intracranial repair should be considered.