Transsellar Transsphenoidal Meningoencephalocele; an Alternative Approach for Repair

Objective: To introduce an alternative surgical approach for repair of the transsellar transsphenoidal meningoencephaloceles (TTSME), which are extremely rare CNS defects and a challenge in surgical management because of the vicinity and even involvement of vital structures of midline diencephalon. Study Design: A case report introducing an alternative approach. Material and Methods: A 36-year-old woman with pituitary dwarfism presented complaining of nasal obstruction. CT scan showed a bony defect in the sellar floor and sphenoid sinus with huge nasopharyngeal mass. In MRI, a true TTSME with third ventricle involvement was detected. Endoscopic endonasal approach was used for repair. The sac was partially removed after close inspection of its contents, and the defect was reconstructed with fat and facial graft, and buttressed with titanium mesh and septal flap. Results: Visual field improvement noticed postoperatively. No complication including postoperative cerebrospinal fluid (CSF) leak or relapse was encountered in 18 months follow-up. Conclusion: Endoscopic endonasal approach was successfully used for repair of a true TTSME. As the case had a huge sac, partial resection of the sac was adopted instead of reduction to not put the optic chiasma in jeopardy.