The endoscopic transpterygoid approach appears to be a viable treatment option for selected patients with an encephalocele or cerebrospinal fluid fistulae from the middle cranial fossa into a lateral sphenoid recess. This case report describes a patient with cerebrospinal fluid leak and seizures in whom a large temporal lobe encephalocele was found. The encephalocele entered the sphenoid sinus through a bony defect in the roof of the lateral recess of a widely pneumatized sphenoid. The endoscopic transpterygoid approach was successfully used to repair the skull base defect. The only disappointing result was that the patient had a reduced sense of smell postoperatively.
References
1.
KaufmanB, YonasH, WhiteRJ, Acquired middle cranial fossa fistulas: Normal pressure and nontraumatic in origin. Neurosurgery1979;5:466–72.
2.
MorleyTP, WortzmanG.The importance of the lateral extensions of the sphenoid post-traumatic cerebrospinal rhinorrhea and meningitis. J Neurosurg1965;22:326–32.
3.
VidicB.The postnatal development of the sphenoidal sinus and its spread into the dorsum sellae and posterior clinoid processes. Am J Roentgenol Radium Ther Nucl Med1968;104:177–83.
4.
SzolarD, PreidlerK, RannerG, Magnetic resonance assessment of age-related development of the sphenoid sinus. British J Radiology1994;67:431–5.
5.
Van AlyeaOE. Sphenoid sinus: Anatomic consideration of the clinical significance of the structural characteristics of the sphenoid sinus. Arch Otolaryngol1941;34:225–53.
6.
NeivertH.Morphologic variation as a factor in the symptomatology of paranasal sinus disease. Arch Otolaryngol1925;1:366.
7.
BolgerWE, ButzinCA, ParsonsDS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope1991;101:56–64.
8.
LanzaDC, O'BrienDA, KennedyDW. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope1996;106:1119–25.
