Endoscopic endonasal repair of spontaneous sphenoid sinus lateral wall meningocele presenting with cerebrospinal fluid leak

ABSTRACTSpontaneous sphenoid sinus lateral wall meningoceles are rare lesions with an unknown etiology. Endoscopic endonasal technique is a considerable route in the treatment of this condition. The aim of this paper is to report the etiology, surgical technique, and outcome in a patient repaired via endoscopic endonasal approach. A 51‑year‑old male patient applied with rhinorrhea started three months ago after an upper respiratory infection. There were no history of trauma or sinus operation. Biochemical analysis of the fluid was positive for beta‑2‑transferrin. This asypthomatic patient had undergone for repairment of lateral sphenoid sinus meningocele with endoscopic endonasal transsphenoidal approach. After endoscopic endonasal meningocele closure procedure no complications occured and a quick recovery was observed. Endoscopic endonasal approach is an effective and safe treatment modality of spontaneous lateral sphenoid sinus meningoceles and efficient in anterior skull base reconstruction.

Key words:Cerebrospinal fluid leak, endoscopic endonasal surgery, meningocele, sphenoid sinus lateral wall,spontaneus

Introductionsinus are infrequent lesions which occur as a result of trauma, iatrogenic injury, or skull base erosion due to inflammatory or neoplastic disorders.[1] Spontaneous meningocele of the sphenoid sinus lateral wall is extremely rare and the theory behind that is the incoplete fusion of sphenoid greater wing embriyologic precursor with presphenoid and basisiphenoid which can be concluded in a persistent channel called the lateral craniopharyngeal (Stenberg) canal.[1,2] Erosion of skull base and increased intracranial pressure with the background of spontaneous meningocele of lateral sphenoid sinus is another suggested theory.[3] Also in congenital skull base, defects may be diagnosed in adulthood incidentally during an investigation for headache, CSF‑rinorrhea or meningitis.[1] Beta 2 transferrin, MRI and CT cisternographies should be done for diagnosis. The main target for the treatment is to prevent complications such as meningitidis, intracranial abscess and pneumocephalus.[4] Traditional treatment for CSF‑leak via craniotomy with 70‑80% success.[4] Besides some known advantages of the transcranial approach, there is a 40% recurrence rate reported with the increased morbidity including anosmia, frontal lobe injury, seisures, memory deficits and intracranial hemorrages.[2,5] Endoscopic endonasal technique eliminates most of the limitations and became highly considerable. With the endoscopic procedure not only an excellent visualization is provided but there are also many outcome studies reporting decreased morbidity rates and improved closure rates.[6] Besides being safe and efficient, endoscopic endonasal surgery is also sufficient in protection of nasal anatomic structures and normal neural functions. In this report, we present a rarely seen case of spontaneous meningocele of lateral sphenoid sinus who received a endoscopic endonasal repair procedure.