Transsphenoidal meningoencephalocele in adults

Jabre, Anthony; Tabaddor, Ronald; Samaraweera, Ranji

doi:10.1016/s0090-3019(00)00270-6

Cited by 50 publications

(44 citation statements)

References 22 publications

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“…When none of these causes can be identified, the encephalocele's pathogenesis can be attributed, as in the case we present here, to the existence of a small defect in the bone, probably congenital in nature, located in the middle cranial fossa, through which cerebral tissue may protrude (4,5,17,22). In the available literature, we were able to find descriptions of only 12 cases of this entity (1,6,9,10,16,20,23,25). Rhinorrhea, recurrent meningitis, and headache are mentioned as the complications of encephalocele, but in no case has the association of rhinorrhea with subdural hematoma (SDH) been described.…”

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confidence: 63%

Intrasphenoidal Encephalocele Associated with Cerebrospinal Fluid Fistula and Subdural Hematomas: Technical Case Report

et al. 2003

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OBJECTIVE AND IMPORTANCE Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported. CLINICAL PRESENTATION A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele. INTERVENTION A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure. CONCLUSION The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.

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confidence: 63%

Intrasphenoidal Encephalocele Associated with Cerebrospinal Fluid Fistula and Subdural Hematomas: Technical Case Report

et al. 2003

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“…In contrast, all eight previous cases of intrasphenoidal encephalocele occurred in middle-aged patients presenting with CSF rhinorrhea. 14,16) Although the pathogenesis remains uncertain, basal temporal encephaloceles are thought to arise either from defective embryological development of the skull base or from postnatal enlargement of small bony dehiscences on the MF floor caused by CSF and brain pulsations. 3) Many adult cases were associated with empty sella turcica, and association with other intracranial anomalies was uncommon.…”

Section: Discussionmentioning

confidence: 99%

“…15,23) Adult patients with true transsphenoidal meningoencephalocele should not undergo surgery, in view of the complex anatomy and the slow progression of symptoms. 14) Adult TSEs can be repaired via extradural MF surgery from above or via an endoscopic transnasal approach from below, but the surgical route has to be tailored and selected according to the size and location of base defect, status of SS pneumatization, CSF pressure, recurrence of CSF leaks, type and failure of prior treatment, and the experience and preference of the surgeon. Some cases of TSEs have been successfully treated via transsphenoidal or transethmoidal routes.…”

Section: Discussionmentioning

confidence: 99%

Middle Fossa Approach to a Temporosphenoidal Encephalocele -Technical Note-

Kwon

Kim

2010

Neurol. Med. Chir.(Tokyo)

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Temporosphenoidal encephalocele (TSE) is a rare entity caused by herniation of the anteromedial temporal lobe into the sphenoid sinus (SS) through a middle fossa (MF) defect. A 45-year-old woman presented with a spontaneous TSE manifesting as a 4-year history of recurrent cerebrospinal fluid rhinorrhea and meningitis. Coronal computed tomography showed a skull defect in the superior wall of the right lateral recess of the SS. This homogeneous intrasphenoidal lesion appeared hypointense on T 1 -weighted magnetic resonance (MR) imaging and hyperintense on T 2 -weighted MR imaging. The patient underwent a frontotemporal craniotomy and extradural MF exploration. The encephalocele was amputated and the temporal base dura primarily sutured and reinforced with fat graft. The MF hole was plugged with temporalis fascia and a calvarial graft layered over the bone defect. Histological examination confirmed meningoencephalocele. Rhinorrhea resolved and the patient remained asymptomatic. Resection of an anteromedial TSE and closure of the craniodural defect in the MF floor via a less invasive extradural skull base approach is effective.

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“…Meningoencephaloceles are anatomically divided into frontal, occipital, parietal and basal types. Basal meningoencephaloceles can also be divided into transethmoidal, sphenoethmoidal, spheno-orbital and transsphenoidal types [1]. The transsphenoidal meningoencephalocele is the rarest one with the incidence of one in every 700,000 live births [2].…”

Section: Introductionmentioning

confidence: 99%

“…A true transsphenoidal meningoencephalocele is the form in which sac contents pass the sphenoid sinus floor and get access to nasal cavity or nasopharynx while an intrasphenoidal meningoencephalocele is restricted to the sphenoid sinus cavity [1]. Transsphenoidal meningoencephalocele can be detected in early infancy due to their critical manifestations such as respiratory distress, feeding problems, endocrine abnormalities, and concomitant craniofacial defects [3].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic repair of transsellar transsphenoidal meningoencephalocele; case report and review of approaches

Jalessi

Jahanbakhshi

Sharifi

et al. 2015

Interdisciplinary Neurosurgery

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We present an extremely rare case of transsellar transsphenoidal meningoencephalocele in a 36-year-old woman with pituitary dwarfism complaining of nasal obstruction. Imaging studies showed a bony defect in the sellar floor and sphenoid sinus with huge nasopharyngeal mass and 3rd ventricle involvement. Using endoscopic endonasal approach the sac was partially removed and the defect was reconstructed with fat and fascial graft, and buttressed with titanium mesh and septal flap. Visual field improvement was noticed post-operatively and no complication was encountered during follow-up. So, endoscopic endonasal approach with partial resection of the sac is a safe and effective treatment for this disease

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Transsphenoidal meningoencephalocele in adults

Cited by 50 publications

References 22 publications

Intrasphenoidal Encephalocele Associated with Cerebrospinal Fluid Fistula and Subdural Hematomas: Technical Case Report

Intrasphenoidal Encephalocele Associated with Cerebrospinal Fluid Fistula and Subdural Hematomas: Technical Case Report

Middle Fossa Approach to a Temporosphenoidal Encephalocele -Technical Note-

Endoscopic repair of transsellar transsphenoidal meningoencephalocele; case report and review of approaches

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