A Le Fort I osteotomy approach to lateral sphenoid sinus encephalocoeles

Reynolds, James M.; Tomkinson, Alun; Grigg, Roger; Perry, Christopher

doi:10.1017/s0022215100141672

Cited by 25 publications

(22 citation statements)

References 4 publications

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“…Historically, transcranial approaches have been used for the surgical management of encephaloceles of the lateral recess of the sphenoid sinus [1,8,10]. There have been reports of external approach to reach the lateral recess of the sphenoid sinus [11]. Rivierez and Valsant [12] used a frontotemporal approach with zygomatic osteotomies for accessing a meningoencephalocele in the right lateral sphenoid recess.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Lateral Sphenoid Recess Cerebrospinal Fluid Leaks

Kirtane

Lall

Chavan

et al. 2011

Indian J Otolaryngol Head Neck Surg

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Endoscopic repair of anterior cranial base has been widely reported. However there is still no uniformity in the technique of endoscopic repair of lateral sphenoid cerebrospinal fluid (CSF) leaks. To highlight the management of CSF leak or encephalocele in the lateral sphenoid recess and relate our experiences. We retrospectively reviewed the medical records of all our patients who underwent an endoscopic repair of CSF leaks in the lateral sphenoid recess during the period from September 2003 to January 2010 at our tertiary hospital. Fifteen cases with CSF leaks/encephalocele that were repaired by the endoscopic approach were included. The majority of our cases were spontaneous leaks. In all our cases we approached the site of defect by an end on approach. All our patients were successfully treated in the first attempt. Endoscopic repair of lateral sphenoid recess has shown better surgical outcome with reduced morbidity.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Lateral Sphenoid Recess Cerebrospinal Fluid Leaks

Kirtane

Lall

Chavan

et al. 2011

Indian J Otolaryngol Head Neck Surg

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“…11,15,28,42,44 Osseous defects located in the anteromedial portion of the middle cranial fossa, or more medially in the region of the sphenoidal wing foramina, could lead to the genesis of encephaloceles protruding into the sphenoid sinus or its lateral recess (anteromedial or lateral sphenoidal encephaloceles). 2,3,5,6,9,10,12,[25][26][27]33,37,40,41,52,54,58 Patients harboring this type of lesion classically present during adulthood with signs and symptoms of CSF rhinorrhea, the subclinical courses of which may lead to recurrent episodes of meningitis and delayed diagnosis. 13,23,24 Herniations of temporal lobe parenchyma and/or meninges may also involve the posterior temporalis bone at the level of the tegmen tympani (posteroinferior or aural encephaloceles).…”

Section: Classificationmentioning

confidence: 99%

“…Extracranial procedures such as transfacial approaches, LeFort osteotomies, and midfacial degloving techniques have also been used for the repair of anteromedial and antero-inferior encephaloceles. 20,33,41 Although these procedures offer the benefit of avoiding consequences directly related to brain manipulation (such as seizure, contusion, or postoperative brain edema), the possibility of a thorough exploration of the middle cranial fossa may be limited when using these routes, thus restricting their usefulness in cases of unclear preoperative localization of the area involved by the dural defect.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Spontaneous encephaloceles of the temporal lobe

Wind

Caputy²,

Roberti³

2008

FOC

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Encephaloceles are pathological herniations of brain parenchyma through congenital or acquired osseus-dural defects of the skull base or cranial vault. Although encephaloceles are known as rare conditions, several surgical reports and clinical series focusing on spontaneous encephaloceles of the temporal lobe may be found in the otological, maxillofacial, radiological, and neurosurgical literature. A variety of symptoms such as occult or symptomatic CSF fistulas, recurrent meningitis, middle ear effusions or infections, conductive hearing loss, and medically intractable epilepsy have been described in patients harboring spontaneous encephaloceles of middle cranial fossa origin. Both open procedures and endoscopic techniques have been advocated for the treatment of such conditions. The authors discuss the pathogenesis, diagnostic assessment, and therapeutic management of spontaneous temporal lobe encephaloceles. Although diagnosis and treatment may differ on a case-by-case basis, review of the available literature suggests that spontaneous encephaloceles of middle cranial fossa origin are a more common pathology than previously believed. In particular, spontaneous cases of posteroinferior encephaloceles involving the tegmen tympani and the middle ear have been very well described in the medical literature.

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“…Patients with idiopathic cerebrospinal rhinorrhea commonly exhibit clinical symptoms and radiographic signs of increased intra-cranial pressure (ICP) as primary empty sella; and a common clinical constellation in these patients is female sex, middle age, and obesity [1][2][3][4][5][6]. The underlying etiology in the majority of individuals in this category is postulated to represent a manifestation of benign intracranial hypertension; therefore, the term ''spontaneous'' is preferred [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

A modification of endoscopic endonasal approach for management of encephaloceles in sphenoid sinus lateral recess

El-Tarabishi

Fawaz

Sabri

et al. 2016

Eur Arch Otorhinolaryngol

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Spontaneous cerebrospinal fluid leak with meningoencephaloceles in sphenoid sinus lateral recess is challenging. Transnasal visualization of this area is difficult, especially when large pneumatization is present. External approaches to this region involve aggressive surgery and are often associated with significant morbidity. The aim of this study is to assess the real effectiveness of a modification of the endoscopic endonasal approach for their management. This is a prospective case series study and was conducted at Otolaryngology department, Ain Shams University Hospitals, Cairo, Egypt. Seven patients with spontaneous cerebrospinal fluid leak with meningoencephaloceles in the sphenoid sinus lateral recess were included. Diagnosis was confirmed by: analysis for beta-2 transferrin and imaging. They were managed with endoscopic endonasal retrograde trans-sphenoid approach described in this study with multilayered reconstruction of the defect. Mean age of our patients was 40.14 ± 8.35 years; mean BMI was 36.37 ± 2.59 kg/m. Primary empty sella was present and osteodural defect was identified in superior wall of sphenoid sinus lateral recess with punched out and regular smooth edges. Mean intra-cranial pressure was (26.42 ± 3.87 mmHO) and size of defect was less than 10 mm, mean 7.85 ± 1.34. Mean-operative time was 169.28 ± 21.87 min. The mean hospital stay was 7.42 ± 1.39 days. No cerebrospinal fluid leak recurrences were observed during follow-up period that ranged from 37 to 48 months. Endoscopic endonasal retrograde trans-sphenoid approach provides a wide, safe, and direct route to the management of sphenoid sinus lateral recess cerebrospinal fluid leak.

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A Le Fort I osteotomy approach to lateral sphenoid sinus encephalocoeles

Cited by 25 publications

References 4 publications

Endoscopic Repair of Lateral Sphenoid Recess Cerebrospinal Fluid Leaks

Endoscopic Repair of Lateral Sphenoid Recess Cerebrospinal Fluid Leaks

Spontaneous encephaloceles of the temporal lobe

A modification of endoscopic endonasal approach for management of encephaloceles in sphenoid sinus lateral recess

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