Endoscopic Repair of Lateral Sphenoid Sinus Meningoencephaloceles

Introduction: Meningoencephaloceles of the lateral sphenoid are uncommon malformations with protrusion of meninges and cerebral tissue through a congenital defect in the floor of the middle cranial fossa. There are no surgical guidelines for their optimal management. Traditionally, the surgical approach was transcranial, which could be challenging given the deep location of these lesions. There are few reports of the endoscopic endonasal approach to this malformation.

Methods: We review a bi-institutional experience of endoscopic repair of lateral sphenoid meningoencephalocele. Medical charts and surgical videos were retrospectively reviewed; the clinical presentation, surgical technique, and outcomes are reported.

Results: Six patients were included. Four were female and two were male, with an average age at presentation of 66 years (SD 21). The clinical manifestations included history of headaches (4/6), CSF rhinorrhea (4/6), ipsilateral ptosis (1/6), photophobia (1/6), nasal obstruction (1/6), and postnasal drip (1/6). The mean duration of symptoms before diagnosis was 54 months. The endoscopic approaches were transnasal (5/6) and transpterygoid (1/6); one patient had a craniotomy as the initial approach and was revised endoscopically. Reconstruction was performed with a fascial graft and septal flap in the six patients; cartilage was additionally used in two. No complications or postoperative leaks were reported. All patients were free of symptoms at most recent follow-up.

Conclusions: With new technology and tools developed in recent years for endoscopic skull base surgery, the resection of lateral sphenoid meningoencephaloceles by the transnasal endoscopic approach is feasible and presents several advantages over the traditional transcranial approaches. Increased awareness of this entity is necessary to aid clinicians in making a timely diagnosis.