Download PDF
J Neurol Surg B Skull Base 2014; 75(05): 314-323
DOI: 10.1055/s-0034-1372465
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Spontaneous Sphenoid Wing Meningoencephaloceles with Lateral Sphenoid Sinus Extension: The Endoscopic Transpterygoid Approach

Abdulrazag Ajlan
1   Department of Neurosurgery, Stanford University, Stanford, California, United States
3   Department of Neurosurgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
,
Achal Achrol
1   Department of Neurosurgery, Stanford University, Stanford, California, United States
,
Ethan Soudry
2   Department of Otolaryngology, Stanford University, Stanford, California, United States
,
Peter H. Hwang
2   Department of Otolaryngology, Stanford University, Stanford, California, United States
,
Griffith Harsh
1   Department of Neurosurgery, Stanford University, Stanford, California, United States
› Author Affiliations
Further Information

Publication History

11 July 2013

27 January 2014

Publication Date:
23 May 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Spontaneous meningoencephalocele (SME) of the sphenoid wing is a rare cause of cerebrospinal fluid (CSF) leakage. Surgical closure of the fistula is usually required. The approach taken depends on the location of the defect and the extension of the meningoencephalocele. The endoscopic transpterygoid approach may be useful. We prospectively analyzed the three cases of SME of the sphenoid wing with lateral sphenoid sinus extension treated endoscopically at Stanford over the last 3 years with regard to imaging findings, operative technique, and operative morbidity. In our three cases, the extent of pterygopalatine fossa (PPF) exposure undertaken, complete in one and partial in two, depended on the defect site. Follow-up ranged from 17 to 25 months. The fistula was completely closed in all three cases. Extant literature reports a 97% rate of successful closure (N = 65 of 67, with a mean follow-up of 25 months) and no major complications. Endoscopic transpterygoid repair is a useful, safe alternative to traditional approaches for repair of SME of the sphenoid wing. Its feasibility depends on the site of the defect, which can be identified by preoperative imaging. Larger PPF exposure and postoperative lumbar drainage of CSF can be useful and have a low risk of morbidity.

Keywords

endoscopic - transpterygoid - meningoencephalocele - sphenoid wing
 

  • References

  • 1 Wind JJ, Caputy AJ, Roberti F. Spontaneous encephaloceles of the temporal lobe. Neurosurg Focus 2008; 25 (6) E11
    PubMedSearch in Google Scholar
  • 2 Landreneau FE, Mickey B, Coimbra C. Surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus. Neurosurgery 1998; 42 (5) 1101-1104; discussion 1104–1105
    CrossrefPubMedSearch in Google Scholar
  • 3 Tomazic PV, Stammberger H. Spontaneous CSF-leaks and meningoencephaloceles in sphenoid sinus by persisting Sternberg's canal. Rhinology 2009; 47 (4) 369-374
    PubMedSearch in Google Scholar
  • 4 Castelnuovo P, Dallan I, Pistochini A, Battaglia P, Locatelli D, Bignami M. Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks. Laryngoscope 2007; 117 (2) 345-349
    CrossrefPubMedSearch in Google Scholar
  • 5 Lopatin AS, Kapitanov DN, Potapov AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003; 129 (8) 859-863
    CrossrefPubMedSearch in Google Scholar
  • 6 Bolger WE. Endoscopic transpterygoid approach to the lateral sphenoid recess: surgical approach and clinical experience. Otolaryngol Head Neck Surg 2005; 133 (1) 20-26
    CrossrefPubMedSearch in Google Scholar
  • 7 Alexander NS, Chaaban MR, Riley KO, Woodworth BA. Treatment strategies for lateral sphenoid sinus recess cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2012; 138 (5) 471-478
    CrossrefPubMedSearch in Google Scholar
  • 8 Schmidt RF, Choudhry OJ, Raviv J , et al. Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles. Neurosurg Focus 2012; 32 (6) E5
    PubMedSearch in Google Scholar
  • 9 Tabaee A, Anand VK, Cappabianca P, Stamm A, Esposito F, Schwartz TH. Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus. J Neurosurg 2010; 112 (5) 1070-1077
    CrossrefPubMedSearch in Google Scholar
  • 10 Tami TA. Surgical management of lesions of the sphenoid lateral recess. Am J Rhinol 2006; 20 (4) 412-416
    CrossrefPubMedSearch in Google Scholar
  • 11 Bachmann-Harildstad G, Kloster R, Bajic R. Transpterygoid trans-sphenoid approach to the lateral extension of the sphenoid sinus to repair a spontaneous CSF leak. Skull Base 2006; 16 (4) 207-212
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Al-Nashar IS, Carrau RL, Herrera A, Snyderman CH. Endoscopic transnasal transpterygopalatine fossa approach to the lateral recess of the sphenoid sinus. Laryngoscope 2004; 114 (3) 528-532
    CrossrefPubMedSearch in Google Scholar
  • 13 Lai SY, Kennedy DW, Bolger WE. Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus. Laryngoscope 2002; 112 (10) 1800-1805
    CrossrefPubMedSearch in Google Scholar
  • 14 Pasquini E, Sciarretta V, Farneti G, Mazzatenta D, Modugno GC, Frank G. Endoscopic treatment of encephaloceles of the lateral wall of the sphenoid sinus. Minim Invasive Neurosurg 2004; 47 (4) 209-213
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Barañano CF, Curé J, Palmer JN, Woodworth BA. Sternberg's canal: fact or fiction?. Am J Rhinol Allergy 2009; 23 (2) 167-171
    CrossrefPubMedSearch in Google Scholar
  • 16 Kenning TJ, Willcox TO, Artz GJ, Schiffmacher P, Farrell CJ, Evans JJ. Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes. Neurosurg Focus 2012; 32 (6) E6
    PubMedSearch in Google Scholar
  • 17 Shetty PG, Shroff MM, Fatterpekar GM, Sahani DV, Kirtane MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol 2000; 21 (2) 337-342
    PubMedSearch in Google Scholar
  • 18 Schick B, Ibing R, Brors D, Draf W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001; 110 (2) 142-147
    CrossrefPubMedSearch in Google Scholar
  • 19 Buchfelder M, Fahlbusch R, Huk WJ, Thierauf P. Intrasphenoidal encephaloceles—a clinical entity. Acta Neurochir (Wien) 1987; 89 (1–2) 10-15
    CrossrefPubMedSearch in Google Scholar
  • 20 Wilkins RH, Radtke RA, Burger PC. Spontaneous temporal encephalocele. Case report. J Neurosurg 1993; 78 (3) 492-498
    CrossrefPubMedSearch in Google Scholar
  • 21 Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19 (1) E6
    PubMedSearch in Google Scholar
  • 22 Kassam AB, Vescan AD, Carrau RL , et al. Expanded endonasal approach: vidian canal as a landmark to the petrous internal carotid artery. J Neurosurg 2008; 108 (1) 177-183
    CrossrefPubMedSearch in Google Scholar
  • 23 Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH. The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg 2010; 113 (5) 967-974
    CrossrefPubMedSearch in Google Scholar
  • 24 Hosseini SM, Razfar A, Carrau RL , et al. Endonasal transpterygoid approach to the infratemporal fossa: correlation of endoscopic and multiplanar CT anatomy. Head Neck 2012; 34 (3) 313-320
    CrossrefPubMedSearch in Google Scholar
  • 25 Daniels DL, Mark LP, Ulmer JL , et al. Osseous anatomy of the pterygopalatine fossa. AJNR Am J Neuroradiol 1998; 19 (8) 1423-1432
    PubMedSearch in Google Scholar
  • 26 Kasemsiri P, Solares CA, Carrau RL , et al. Endoscopic endonasal transpterygoid approaches: anatomical landmarks for planning the surgical corridor. Laryngoscope 2013; 123 (4) 811-815
    CrossrefPubMedSearch in Google Scholar
  • 27 Fortes FS, Sennes LU, Carrau RL , et al. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model. Laryngoscope 2008; 118 (1) 44-49
    CrossrefPubMedSearch in Google Scholar
  • 28 Kassam AB, Prevedello DM, Carrau RL , et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 2011; 114 (6) 1544-1568
    CrossrefPubMedSearch in Google Scholar
  • 29 Tosun F, Carrau RL, Snyderman CH, Kassam A, Celin S, Schaitkin B. Endonasal endoscopic repair of cerebrospinal fluid leaks of the sphenoid sinus. Arch Otolaryngol Head Neck Surg 2003; 129 (5) 576-580
    CrossrefPubMedSearch in Google Scholar
  • 30 Bernal-Sprekelsen M, Alobid I, Mullol J, Trobat F, Tomás-Barberán M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology 2005; 43 (4) 277-281
    PubMedSearch in Google Scholar