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2014 ; 75
(5
): 314-23
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Spontaneous sphenoid wing meningoencephaloceles with lateral sphenoid sinus
extension: the endoscopic transpterygoid approach
#MMPMID25302142
Ajlan A
; Achrol A
; Soudry E
; Hwang PH
; Harsh G
J Neurol Surg B Skull Base
2014[Oct]; 75
(5
): 314-23
PMID25302142
show ga
Spontaneous meningoencephalocele (SME) of the sphenoid wing is a rare cause of
cerebrospinal fluid (CSF) leakage. Surgical closure of the fistula is usually
required. The approach taken depends on the location of the defect and the
extension of the meningoencephalocele. The endoscopic transpterygoid approach may
be useful. We prospectively analyzed the three cases of SME of the sphenoid wing
with lateral sphenoid sinus extension treated endoscopically at Stanford over the
last 3 years with regard to imaging findings, operative technique, and operative
morbidity. In our three cases, the extent of pterygopalatine fossa (PPF) exposure
undertaken, complete in one and partial in two, depended on the defect site.
Follow-up ranged from 17 to 25 months. The fistula was completely closed in all
three cases. Extant literature reports a 97% rate of successful closure (N?=?65
of 67, with a mean follow-up of 25 months) and no major complications. Endoscopic
transpterygoid repair is a useful, safe alternative to traditional approaches for
repair of SME of the sphenoid wing. Its feasibility depends on the site of the
defect, which can be identified by preoperative imaging. Larger PPF exposure and
postoperative lumbar drainage of CSF can be useful and have a low risk of
morbidity.