Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus

Object Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare lesions that are hypothesized to result from persistence of the lateral craniopharyngeal canal. Prior reports of the management of this lesion have been limited by its relative rarity. The objective of this paper is to report the theoretical etiology, surgical technique, and outcomes in patients undergoing endoscopic repair of spontaneous meningoencephalocele of the sphenoid sinus. Methods The authors conducted a retrospective review of a multiinstitutional series of 13 cases involving patients who underwent endoscopic repair of spontaneous meningoencephalocele of the lateral sphenoid sinus. The surgical technique and pathophysiological considerations are discussed. Results The clinical manifestations included CSF rhinorrhea (85%), chronic headache (77%), and a history of meningitis (15%). The endoscopic approaches to the lateral sphenoid sinus were transnasal (39%), transpterygoid (23%), and transethmoid (39%). Two patients (8%) had postoperative CSF leaks, one of which closed spontaneously and one of which required revision endoscopic closure. All patients were free of leak at most recent follow-up. One patient experienced postoperative meningitis in the early postoperative period. Conclusions Endoscopic endonasal closure is an effective modality in the treatment of spontaneous meningoencephaloceles of the lateral sphenoid sinus. If the sphenoid sinus has extensive lateral pneumatization, adequate exposure may require a transpterygoid approach.

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Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

Neurosurgical FOCUS ◽

10.3171/2012.3.focus1267 ◽

2012 ◽

Vol 32 (6) ◽

pp. E5 ◽

Cited By ~ 30

Author(s):

Richard F. Schmidt ◽

Osamah J. Choudhry ◽

Joseph Raviv ◽

Soly Baredes ◽

Roy R. Casiano ◽

...

Keyword(s):

Skull Base ◽

Sphenoid Sinus ◽

Skull Base Surgery ◽

Surgical Anatomy ◽

Endoscopic Endonasal ◽

Csf Rhinorrhea ◽

Lateral Recess ◽

Sternberg Canal ◽

Deep Location ◽

Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

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Endoscopic anatomy of the sphenoid sinus and sella turcica

The Journal of Laryngology & Otology ◽

10.1017/s0022215100131743 ◽

1995 ◽

Vol 109 (10) ◽

pp. 951-955 ◽

Cited By ~ 54

Author(s):

Dharambir S. Sethi ◽

Ralph E. Stanley ◽

Prem Kumar Pillay

Keyword(s):

Surgical Technique ◽

Sphenoid Sinus ◽

Sella Turcica ◽

Endoscopic Management ◽

Operating Microscope ◽

Anatomical Features ◽

Endoscopic Techniques ◽

Endoscopic Anatomy ◽

Sellar Lesions ◽

Endoscopic Study

AbstractAn endoscopic study of the sphenoid sinus was carried out, on 30 cadavers, to understand the important anatomical relationships of the sphenoid sinus, and the sella turcica. The aim was to study the endoscopic anatomy and the variants, and to determine if endoscopic instrumentation and techniques, could play a beneficial role in endoscopic management of sellar lesions.The results of this study are discussed, with particular reference to the important surgical anatomical features of the sphenoid sinus. A surgical technique for the endoscopic transsphenoid approach to the sella turcica was developed.Anatomical variants can be identified endoscopically, and endoscopic techniques have the advantages of improved visualization, magnification, angled vision, and a panoramic perspective of the intrasphenoid anatomy, compared to currently employed methods of pituitary/sellar surgery, using the operating microscope/.

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Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4478 ◽

2017 ◽

Vol 31 (6) ◽

pp. 406-411 ◽

Cited By ~ 7

Author(s):

Javaneh Jahanshahi ◽

Mehdi Zeinalizadeh ◽

Hasan Reza Mohammadi ◽

Seyed Mousa Sadrehosseini

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Frontal Sinus ◽

Surgical Approaches ◽

Endoscopic Management ◽

Graft Material ◽

Endoscopic Repair ◽

Skull Base Reconstruction ◽

Csf Rhinorrhea

Background A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. Objective To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. Methods Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated. Results Among >100 cases of surgically repaired CST rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Tree autografts as two-layer inlay fat–muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients. Conclusion Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

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Spontaneous CSF Leaks and Meningoencephaloceles: Endoscopic Repair and Possible Etiology

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1074 ◽

2011 ◽

Vol 3 (3) ◽

pp. 151-155

Author(s):

Andrey S Lopatin ◽

Dmitry N Kapitanov ◽

Alexander A Potapov

Keyword(s):

Success Rate ◽

Endoscopic Surgery ◽

Sphenoid Sinus ◽

Lateral Part ◽

Nasal Discharge ◽

Bony Defect ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Etiological Factors ◽

Csf Fistula

ABSTRACT Objective To assess the outcomes of endonasal endoscopic repair of spontaneous cerebrospinal fluid (CSF) rhinorrhea and to analyze its possible etiological factors. Patients During the period between January 1999 and November 2011, 173 patients who presented with spontaneous CSF rhinorrhea underwent endonasal endoscopic surgery. Preoperative examination included CT scans, nasal endoscopy, measurement of glucose concentration in the nasal discharge and, in some cases, cisternographic evaluation via CT or MRI. CSF fistula closure was performed using endonasal endoscopic technique under general anesthesia. In all, 186 surgeries (173 primary attempts and 13 revisions) were carried out over the 12-year period. A combination of different plastic materials, i.e. nasal septum cartilage, facia lata, abdominal fat, rotating middle turbinate flaps, and fibrin glue was used for fistula repair. Results At the time of the surgery, sites of the CSF fistula were determined as follows: Cribriform plate—70, fovea ethmoidalis—55, sphenoid sinus—45, frontal sinus—3. Extremely pneumatized lateral extension of the sphenoid sinus was found in 26 patients, and a meningo/encephalocele protruding through the bony defect was the source of the leak in 23 of them. In terms of up to 11 years, 165 patients were treated successfully after first attempt and five more recovered after revision endoscopic surgery. Success rate after the first surgery was 95.4%, overall success rate—97.7%. There were no postoperative complications. Conclusion Possible etiological factors of this disease include obesity, innate skull base malformations, overpneumatized sphenoid sinus, particularly presence of its lateral extensions and the empty sella syndrome. Endoscopic endonasal repair of spontaneous CSF rhinorrhea appears to be a safe and successful procedure. However, technique of endoscopic closure of CSF fistulas in the lateral part of the sphenoid sinus needs further perfection.

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Endoscopic Endonasal Transsphenoidal Surgery

Neurosurgery ◽

10.1227/01.neu.0000137330.02549.0d ◽

2004 ◽

Vol 55 (4) ◽

pp. 933-941 ◽

Cited By ~ 254

Author(s):

Paolo Cappabianca ◽

Luigi Maria Cavallo ◽

Enrico de Divitiis

Keyword(s):

Surgical Technique ◽

Nasal Septum ◽

Transsphenoidal Surgery ◽

Sphenoid Sinus ◽

Surgical Instruments ◽

Endoscopic Endonasal ◽

Minimally Invasive Surgical ◽

Endoscopic Endonasal Transsphenoidal Surgery ◽

Microsurgical Procedure ◽

Sellar Floor

Abstract THE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. The procedure is performed via an anterior sphenoidotomy. The two main characteristics of the endoscopic approach, when compared with the standard microsurgical operation, arise from the use of the endoscope as a unique optical device and from the absence of a transsphenoidal retractor. More convenient straight surgical instruments are employed, whereas bayonet-shaped tools are used in the microsurgical procedure, to avoid any interference with the light beam generated by the microscope. The standard surgical technique is composed of three main time phases: the nasal, sphenoid, and sellar phase. During the nasal phase, the scope is introduced through the chosen nostril and advanced up to the sphenoethmoid recess, where the sphenoidotomy is performed. The sphenoid phase consists of the detachment of the nasal septum from the sphenoid rostrum, the anterior sphenoidotomy, removal of the sphenoid septum or septa, and identification of the landmarks inside the sphenoid sinus. In the sellar phase, an opening of the sellar floor is performed for removal of the lesion. A wide view of the sellar environment is obtained through angled scopes to detect eventual tumor remnants. The procedure ends with the reconstruction of the sella and removal of the endoscope from the nostril, without any postoperative nasal packing.

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Endoscopic Management of Lacrimal System Dysgenesis and Dacryocystoceles in Fraser Syndrome: A Case Report and Literature Review

Allergy & Rhinology ◽

10.1177/2152656718804905 ◽

2018 ◽

Vol 9 ◽

pp. 215265671880490

Author(s):

Megan E. Falls ◽

Michael P. Rabinowitz ◽

Jacqueline R. Carrasco ◽

Mindy R. Rabinowitz

Keyword(s):

Case Report ◽

Literature Review ◽

Autosomal Recessive ◽

Clinical Manifestations ◽

Autosomal Recessive Disorder ◽

Ambiguous Genitalia ◽

Endoscopic Management ◽

Endoscopic Endonasal ◽

Fraser Syndrome ◽

Lacrimal System

Background Fraser syndrome is an autosomal recessive disorder characterized primarily by syndactyly, cryptophthalmos, urinary tract anomalies, ambiguous genitalia, and laryngeal anomalies. A 28-year-old man with Fraser syndrome presented with cryptophthalmos, microphthalmia, lacrimal system dysgenesis, and chronic sinusitis. Objective The patients’ clinical condition and surgical treatment are described. A literature review was conducted, and articles relevant to the case are presented. Methods Case report. Results To our knowledge, this is the first published case report of endonasal management of dacryocystoceles in a Fraser syndrome patient. The patient was treated via endoscopic endonasal marsupialization and drainage. Conclusion Fraser syndrome patients may initially present to many different specialties as the spectrum of clinical manifestations is broad. Physicians treating these patients should take a collaborative approach to surgical and medical management.

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