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Basheer N, Raj A, Mathew J, Alapatt J. Trans-sellar-trans-sphenoidal encephalocele presenting as nasal obstruction in an infant: a case report and systematic review of existing reports. Childs Nerv Syst 2023:10.1007/s00381-023-05956-7. [PMID: 37055485 DOI: 10.1007/s00381-023-05956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Trans-sellar trans-sphenoidal encephalocele is a rare congenital anomaly, with only around 20 cases having been documented in literature around the world. Surgical repair of these defects in the pediatric population commonly uses either the transcranial or the transpalatal approach, with the choice of approach being individualized based on the clinical features, age, and associated defects present in the patient. Here, we document a case of a 4-month-old child who presented to us with nasal obstruction, who was diagnosed with this rare entity and successfully underwent a transcranial repair for the same. We also provide a systematic review of all existing case reports that have described this rare condition in the pediatric population, as weel as the different surgical approaches used in each case.
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Affiliation(s)
- Noufal Basheer
- Department of Neurosurgery, Aster MIMS, Kozhikode, Kerala, India
| | - Aiswarya Raj
- Department of Neurology, Aster MIMS, Kozhikode, Kerala, India.
| | - Jim Mathew
- Department of Neurosurgery, Aster MIMS, Kozhikode, Kerala, India
| | - Jacob Alapatt
- Department of Neurosurgery, Aster MIMS, Kozhikode, Kerala, India
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Persisting embryonal infundibular recess (PEIR) and transsphenoidal-transsellar encephaloceles: distinct entities or constituents of one continuum? Childs Nerv Syst 2022; 38:1059-1067. [PMID: 35192025 DOI: 10.1007/s00381-022-05467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
Persisting embryonal infundibular recess (PEIR) is a very rare anomaly of the floor of the third ventricle in which the embryonic morphology of the infundibular recess (IR) persists. The exact underlying mechanism of development of PEIR is unknown, and the anomaly has been reported as an isolated finding or in association with other conditions. On the other hand, trans-sphenoidal encephaloceles are the rarest form of basal encephaloceles. The trans-sphenoidal trans-sellar encephalocele (TSE) is the least common variant in which the pituitary gland, pituitary stalk, optic pathways, parts of the third ventricle and IR may be present within the encephalocele. We recently treated one patient with TSE. Based on the observed morphological similarity of the IR in our patient and in the published cases of PEIR, we reviewed the literature in order to validate the hypothesis that PEIR and TSE may possibly belong to one spectrum of malformations. Across the published reports, the morphology of the IR in TSE is very closely similar to PEIR. Moreover, radiological, patho-anatomical, and embryological evidence is in support to our hypothesis that PEIR and TSE are most likely the two extremes of the same continuum of malformations.
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Novak V, Hrabalek L, Hoza J, Tuckova L, Pohlodek D. Transnasal endoscopic surgery of sphenoid meningocele associated with pituitary adenoma. A case report. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:343-346. [PMID: 34446940 DOI: 10.5507/bp.2021.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transsphenoid meningoencephalocele is a congenital anomaly formed by herniation of an ependyma delimited sac through a bony defect into the sphenoid sinus. The sac contains cerebrospinal fluid and neurovascular structures. The prevalence of transsphenoid meningoencephalocele in the adult population is rare. It usually manifests as nasal liquorrhoea. METHODS AND RESULTS This case report presents an adult male who underwent surgery due to suspected pituitary macroadenoma. The surgery was performed endoscopically via the transnasal approach with a surprising finding of true transsphenoid meningoencephalocele. Ectopic solid tissue was found in the sphenoid sinus in which pituitary adenoma was histologically confirmed. CONCLUSION This paper presents a previously unpublished combination of true transsphenoid meningoencephalocele and pituitary adenoma in an adult individual.
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Affiliation(s)
- Vlastimil Novak
- Department of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Lumir Hrabalek
- Department of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jiri Hoza
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Lucie Tuckova
- Institute of Clinical and Molecular Pathology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Kobets AJ, Redett RJ, Walsh JM, Lopez J, Guryildirim M, Cohen AR. Repair of Giant Anterior Skull Base Encephalocele Containing Intralesional Eloquent Brain: Technical Note. Oper Neurosurg (Hagerstown) 2021; 21:73-80. [PMID: 33861350 DOI: 10.1093/ons/opab088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 01/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Encephaloceles are herniations of intracranial neural tissue and meninges through defects in the skull. Basal encephaloceles are rare anterior skull base defects incident in 1 in 35,000 live births. Sphenoethmoidal encephaloceles are even more uncommon, with an incidence of 1 in 700,000 live births. Anterior skull base encephaloceles may be life-threatening in infants, presenting as airway obstruction and respiratory compromise. They can also present with cerebrospinal fluid (CSF) rhinorrhea, purulent nasal drainage, or meningitis. OBJECTIVE To report a novel technique for repairing a giant sphenoethmoidal encephalocele containing eloquent neural tissue. METHODS A 16-mo-old girl presented with progressive airway obstruction from a giant sphenoethmoidal encephalocele that filled her oral cavity. She had multiple congenital anomalies including agenesis of the corpus callosum and cleft lip and palate. Computed tomography showed complete absence of the bony anterior cranial base, and magnetic resonance imaging demonstrated the presence of the pituitary gland and hypothalamus in the hernia sac. RESULTS We repaired the encephalocele using a combined microsurgical and endoscopic multidisciplinary approach working through transcranial, transnasal, and transpalatal corridors. The procedure was completed in a single stage, during which the midline cleft lip was also repaired. The child made an excellent neurological and aesthetic recovery with preservation of pituitary and hypothalamic function, without evidence of CSF fistula. CONCLUSION The authors describe a novel multidisciplinary technique for treating a giant sphenoethmoidal encephalocele containing eloquent brain. The cleft lip was also repaired at the same time. The ability to work through multiple corridors can enhance the safety and efficacy of an often-treacherous operative endeavor.
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Affiliation(s)
- Andrew J Kobets
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan M Walsh
- Department of Otolaryngology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Lopez
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melike Guryildirim
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan R Cohen
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Transsellar trans-sphenoidal encephalocele with cleft lip, cleft palate and agenesis of corpus callosum. Radiol Case Rep 2021; 16:2211-2213. [PMID: 34178194 PMCID: PMC8213976 DOI: 10.1016/j.radcr.2021.05.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 11/23/2022] Open
Abstract
Basal encephalocele is a rare congenital malformation. Among basal encephaloceles, the transsellar, trans-sphenoidal encephalocele is the least common subtype. We present the case of a newborn female, who presented to us with cleft lip and cleft palate. Diagnostic neuroimaging revealed the presence of transsellar trans-sphenoidal encephalocele along with agenesis of the corpus callosum. There are very few case reports of trans-sphenoidal encephalocele with corpus callosum agenesis in a patient with midline cleft lip and palate. In this report, we discuss the clinico-radiological findings of this extremely rare condition and present a brief review of the literature.
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Kasim N, Choudhri A, Alemzadeh R. Craniopharyngeal canal, morning glory disc anomaly and hypopituitarism: what do they have in common? Oxf Med Case Reports 2018; 2018:omy018. [PMID: 29977576 PMCID: PMC6007484 DOI: 10.1093/omcr/omy018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/23/2018] [Accepted: 04/10/2018] [Indexed: 12/02/2022] Open
Abstract
A 14-year-old girl with a history of mid-line defects, basal encephalocele and morning glory disc anomaly presented with untreated growth hormone deficiency, pubertal delay and hypothyroidism. She was found to have a large craniopharyngeal canal based on MRI scan. Craniopharyngeal canal is an uncommon condition that has not been well described in the pediatric population. Consideration of craniopharyngeal canal in the differential diagnosis for basal encephaloceles and understanding its presentation can impact medical decision making and follow-up for patients.
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Affiliation(s)
- Nader Kasim
- Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Asim Choudhri
- Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ramin Alemzadeh
- Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, USA
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Sakharov AV, Roginskiy VV, Kapitanov DN, Ivanov AL, Shelesko EV, Gorelyshev SK, Evteev AA, Lemeneva NV, Zinkevich DN, Kochkin YA, Ozerova VI, Satanin LA. [Modern diagnosis and treatment in children with congenital basal encephalocele]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 81:30-38. [PMID: 28665386 DOI: 10.17116/neiro201781330-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Basal encephalocele is a rare disease that predominantly occurs in children. Its most common symptoms include nasal liquorrhea, difficulty in nasal breathing, and deformity of the naso-orbital region. MATERIAL AND METHODS The study group included 19 patients with basal encephalocele, aged 2 months to 18 years. Ten (59%) patients were operated on through a transnasal endoscopic approach; 3 (17.5%) patients were operated on through a transcranial approach; 4 (23.5%) patients were operated on using a combined approach: the patients underwent simultaneous elimination of a cranio-orbital region deformity using the basal transcranial approach as well as hernial sac resection and hernioplasty using the transnasal endoscopic approach. Two children had no surgery due to minimal symptoms and a lack of cerebrospinal fluid leak. RESULTS Application of the algorithms for diagnosis and treatment of encephalocele, suggested by the authors, enabled making the timely diagnose, defining the optimal surgical tactics, and achieving good treatment results. CONCLUSION A differentiated approach to the choice of a surgical technique for basal encephalocele, the use of auto-tissues for skull base reconstruction, intraoperative and postoperative lumbar drainage, and simultaneous elimination of deformity of the fronto-naso-orbital region enable avoiding complications and achieving good functional and aesthetic results.
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Affiliation(s)
- A V Sakharov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - V V Roginskiy
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - A L Ivanov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - E V Shelesko
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Evteev
- Research Institute and Museum of Anthropology of the Moscow State University, Moscow, Russia
| | - N V Lemeneva
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - Yu A Kochkin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - V I Ozerova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - L A Satanin
- Burdenko Neurosurgical Institute, Moscow, Russia
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Pineyro MM, Furtenbach P, Lima R, Wajskopf S, Sgarbi N, Pisabarro R. Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy. Front Endocrinol (Lausanne) 2017; 8:192. [PMID: 28824551 PMCID: PMC5545576 DOI: 10.3389/fendo.2017.00192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/24/2017] [Indexed: 11/13/2022] Open
Abstract
Brain and optic chiasm herniation has been rarely reported following dopamine agonist treatment for large prolactinomas. We report a case of brain and optical chiasm herniation, secondary to an empty sella due to apoplexy of a prolactinoma, and we focus on the specific presentation of this case. A 32-year-old female presented to a neurologist complaining of headaches. Her past medical history was significant for acute vision loss in both eyes accompanied by right third nerve palsy when she was 16 years old. She does not recall any endocrine or imaging evaluation at that time and she had spontaneous partial recovery of left eye vision within 3 months, with permanent blindness of right eye. She did not return to any follow-up until her neurologist consultation. Brain magnetic resonance imaging (MRI) revealed herniation of frontal lobe and optic chiasm into the pituitary sella, as well as a pituitary hypointense lesion measuring 5 mm × 5 mm after gadolinium injection. Prolactin levels were 206 ng/ml (4.79-23.3 ng/ml). Repeated prolactin was 258 ng/ml (4.79-23.3 ng/ml). She was started on bromocriptine 2.5 mg/day. Prolactin levels and menstrual cycles normalized. A repeat brain MRI performed 5 months later showed disappearance of pituitary mass, with no changes in brain and chiasmal herniation. To our knowledge, this is the first reported case of brain associated with chiasm herniation secondary to pituitary apoplexy of a prolactinoma. In conclusion, this case highlights that frontal lobe herniation in combination with optic chiasm herniation can be a complication of pituitary tumor apoplexy. Long-term surveillance of patients with pituitary apoplexy is warranted to detect delayed complications.
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Affiliation(s)
- Maria M. Pineyro
- Clínica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- *Correspondence: Maria M. Pineyro,
| | - Patricia Furtenbach
- Clínica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ramiro Lima
- Neurocirugía, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Saul Wajskopf
- Neurocirugía, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Nicolas Sgarbi
- Imagenología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Raul Pisabarro
- Clínica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Jalessi M, Jahanbakhshi A, Sharifi G, Azar JM, Farhadi M, Mobasseri A. Endoscopic repair of transsellar transsphenoidal meningoencephalocele; case report and review of approaches. INTERDISCIPLINARY NEUROSURGERY 2015. [DOI: 10.1016/j.inat.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Illing E, Schlosser RJ, Palmer JN, Curé J, Fox N, Woodworth BA. Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg's canal. Int Forum Allergy Rhinol 2014; 4:246-50. [PMID: 24407877 DOI: 10.1002/alr.21262] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/15/2013] [Accepted: 10/29/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spontaneous cerebrospinal fluid (CSF) leaks/encephaloceles are proven to be associated with intracranial hypertension by objective measurements of CSF pressure during or following endoscopic repair. A common area of involvement is a pneumatized lateral recess of the sphenoid (LRS) sinus, where prolonged intracranial pressures lead to arachnoid pits and subsequent development of skull-base defects. Even though the LRS is never present at birth, a "congenital" cause of these leaks due to a persistent Sternberg's (lateral craniopharyngeal) canal continues to be erroneously perpetuated in the literature. The objective of this study was to eliminate the myths defining these leaks as congenital in nature. METHODS Evaluation of LRS CSF leaks present within a multiinstitutional case series was performed. Data regarding demographics, body mass index (BMI), radiologic evaluation of intracranial hypertension, and direct intracranial pressure measurements (when available) were collected. RESULTS Data evaluation identified 77 LRS CSF leaks in 59 patients (mean age 52 years). Obesity was present in 83% of individuals (mean BMI 36) and 81% were females. Radiologic evidence of intracranial hypertension (eg, empty sella, dilated optic nerve sheaths, and scalloped/attenuated bone) was present on 96% of preoperative computed tomography (CT) and/or magnetic resonance imaging (MRI) scans. Opening or postsurgical lumbar drain or ventriculostomy pressure measurements were elevated in 95% of patients (mean 27.7; range, 9-50 cmH2 O). CONCLUSION This study provides objective evidence that LRS CSF leaks are secondary to erosions from intracranial hypertension and refutes the myth regarding a congenital origin from Sternberg's canal.
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Affiliation(s)
- Elisa Illing
- Department of Surgery, Division of Otolaryngology, Medical University of South Carolina, Charleston, SC
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Waseem M, Upadhyay R, Al-Husayni H, Agyare S. Intrasphenoidal encephalocele: an incidental finding in emergency department. Int J Emerg Med 2013; 6:45. [PMID: 24314115 PMCID: PMC4028804 DOI: 10.1186/1865-1380-6-45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/13/2013] [Indexed: 11/30/2022] Open
Abstract
Background Basal encephaloceles are rare clinical entities. Intrasphenoidal encephalocele (ISE) is a rare form of basal encephalocele. The clinical presentation is often subtle and may remain undetected. Only a limited number of cases of ISE have been reported, mostly in middle-aged patients who presented with symptoms. Clinical diagnosis and management remain a challenge. Our case reports ISE as an incidental finding in a very elderly male patient. Findings We present a case of ISE discovered as an incidental finding in a 99-year-old male who presented to the emergency department (ED) after a fall from bed. The encephalocele was discovered in the evaluation of the computed tomography (CT) scan of the head. Conclusion This is an incidental manifestation of a rare disease. It demonstrates that these encephaloceles may not manifest clinically or symptomatically as other reports have suggested.
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Affiliation(s)
- Muhammad Waseem
- Lincoln Medical & Mental Health Center, 234 East 149th Street, Bronx, NY 10451, USA.
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Ogiwara H, Morota N. Surgical treatment of transsphenoidal encephaloceles: transpalatal versus combined transpalatal and transcranial approach. J Neurosurg Pediatr 2013; 11:505-10. [PMID: 23495807 DOI: 10.3171/2013.2.peds12231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Transsphenoidal encephalocele (TSEC) is a rare developmental anomaly with herniation of neural elements including pituitary gland or optic apparatus, through a defect of sphenoid bone. To prevent obstructive dyspnea, endocrine dysfunction, or visual disturbance, surgical correction is usually performed. However, the optimal operative approach has not been determined yet. The authors present their surgical experiences with transpalatal, transcranial, or combined approach. METHODS The authors retrospectively analyzed surgical results in patients with TSEC. The charts were reviewed for demographic data, clinical presentation, surgical therapy, and clinical outcomes. RESULTS Seven consecutive patients with TSEC were surgically treated between March 2004 and February 2012. The mean age was 23.9 months (range 2-69 months). Four patients with TSEC who had a bone defect within the sphenoid bone were successfully treated using a transpalatal approach. Two patients with an extensive sphenoethmoidal bone defect that was treated either by a transpalatal or transcranial approach experienced several relapses with a prolapse of the encephalocele. One patient with an extensive sphenoethmoidal bone defect was successfully treated by combined transpalatal and transcranial approach without relapse for 3.6 years. CONCLUSIONS The combined transpalatal and transcranial approach is useful for TSEC with an extensive sphenoethmoidal bone defect to dissect the sac and expose the bone defect circumferentially. If dissection is not sufficient, relapse with a prolapse of the encephalocele can ensue. The transpalatal approach is sufficient for TSEC in which a bone defect is limited within the sphenoid bone.
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Affiliation(s)
- Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan.
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Sanjari R, Mortazavi SA, Amiri RS, Ardestani SHS, Amirjamshidi A. Intrasphenoidal Meningo-encephalocele: Report of two rare cases and review of literature. Surg Neurol Int 2013; 4:5. [PMID: 23494001 PMCID: PMC3589850 DOI: 10.4103/2152-7806.106260] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/03/2012] [Indexed: 11/08/2022] Open
Abstract
Background: Transsphenoidal encephaloceles represent a rare clinical entity with wide range of symptoms in adult. Such lesions require accurate diagnosis and surgical treatment. The incidence of congenital encephalocele is very low occurring in approximately 1 in 3000-5000 live births. Even though 63 similar cases have been reported in the literature not all of them have been discussed completely. Due to the rare occurrence of these lesions, we will focus on the main clues in the diagnosis and management of such lesions, which are challenging. Case Description: We intend to present our experience with two cases of trans-sphenoidal meningoencephalocels, one located medially and the other herniating through the Sternberg's canal. The younger was 17 and the elder was 47 years old and both of them presented with cerebrospinal fluid (CSF) leakage. Both patients were treated successfully using pure endoscopic endonasal approach. Conclusion: Ideal surgical approach for such patients is still not clear due to lack of adequate experience in the literature, it is suggested that full preoperative imaging studies might lead the surgeons to undertake minimally invasive skull base approaches in similar patients.
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Affiliation(s)
- Reza Sanjari
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
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Saito K, Toda M, Sano K, Tomita T, Ogawa K, Yoshida K. Application of the endoscopic transsphenoidal approach to true type transsellar transsphenoidal meningoencephalocele in an adult: a case report and literature review. Acta Neurochir (Wien) 2012; 154:1511-5. [PMID: 22531964 DOI: 10.1007/s00701-012-1346-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 03/27/2012] [Indexed: 11/30/2022]
Abstract
Of the transsellar transsphenoidal meningoencephaloceles (TTSMEs), the true type presents with the hernial sac extending from the intracranium to the epipharynx through the sellar floor. The true type is the most serious and difficult to manage, especially when the hernial sac contains vital structures, such as the anterior cerebral artery, pituitary gland, optic nerve, hypothalamus, and third ventricle. Surgical outcome for true type TTSME is reported to be poor. We describe a successful case of endoscopic repair for a 36-year-old man with true type TTSME. Our success with endoscopic repair for true type TTSME in an adult is the first reported case. We believe that the endoscopic transsphenoidal approach allows less invasive surgery and provides an acceptable operative outcome in comparison with other microsurgical approaches.
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Affiliation(s)
- Katsuya Saito
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjnku-ku, Tokyo, 160-8582, Japan.
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Chen G, Zhang Q, Ling F. An endoscopic endonasal approach for the surgical repair of transsphenoidal cephalocele in children. J Clin Neurosci 2011; 18:723-4. [PMID: 21420299 DOI: 10.1016/j.jocn.2010.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 08/23/2010] [Accepted: 08/24/2010] [Indexed: 10/18/2022]
Abstract
Transsphenoidal cephalocele is a rare lesion traditionally managed by either an intracranial approach or by a combined intracranial and extracranial approach. A two-year-old boy presented with a transsphenoidal cephalocele manifesting as apneic-cyanotic spells accompanied by breathing difficulties due to nasal obstruction after birth. Neuroimaging revealed a cystic mass extending from the pituitary fossa into the nasopharynx through the sphenoid sinus. Nasal endoscopy confirmed the diagnosis of transsphenoidal meningocephalocele. The lesion was managed with an endoscopic endonasal approach. The cephalocele and its contents were passively reduced by applying bipolar cautery to the overlying mucosa. Once reduced, the mucosa was incised and removed from the underlying dura to allow further reduction of the dural sac and its contents. The dural sac was amputated partially using microscissors, followed by repair of the dural defect. The patient developed mild diabetes insipidus after surgery. Follow-up evaluation demonstrated resolution of the preoperative symptoms without lasting morbidity. This procedure is safe, less time consuming than the transcranial approach, and efficacious.
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Affiliation(s)
- Ge Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xuanwu District, Beijing 100053, China
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Tanimoto K, Onda S, Sawaki H, Hiraiwa T, Sano H, Ohnishi M, Terasaki J, Hanafusa T. Hypopituitarism in a patient with transsphenoidal cephalocele: longitudinal changes in endocrinological abnormalities. Endocr J 2011; 58:193-8. [PMID: 21325746 DOI: 10.1507/endocrj.k10e-405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a 21-year-old man with severe fatigue due to hypopituitarism. At the age of 6 years, he was diagnosed with short stature due to a GH deficiency accompanied by a sphenoid cystic lesion. Laboratory findings and provocative tests for pituitary hormone function revealed ACTH, LH, FSH, TSH, and GH deficiency. Computed tomography and magnetic resonance imaging revealed transsphenoidal cephalocele due to a defect in the floor of the sella turcica. At 6 years, he only had severe GH deficiency and poor response of LH to LHRH. Hypothalamic-pituitary dysfunction and pituitary herniation have progressed subsequently; we observed a longitudinal progression of hypothalamic-pituitary dysfunction caused by transsphenoidal cephalocele. This dysfunction requires the selection of a treatment that will not aggravate the condition further.
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Affiliation(s)
- Keiji Tanimoto
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Japan.
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17
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Kwon JE, Kim E. Middle fossa approach to a temporosphenoidal encephalocele -technical note-. Neurol Med Chir (Tokyo) 2010; 50:434-8. [PMID: 20505307 DOI: 10.2176/nmc.50.434] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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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Affiliation(s)
- Jae Eun Kwon
- Division of Skull Base Surgery, Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Jung-gu, Daegu, Republic of Korea
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18
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Abstract
BACKGROUND Transsphenoidal encephaloceles are rare cystic herniations of meninges, cerebrospinal fluid, and/or brain matter resulting from incomplete closure of the cranial base and may be associated with midfacial, central nervous system, and endocrine anomalies. Although some centers choose not to operate because of risks, the authors document their staged operative approach to avoid recurrent meningitis, progressive neurologic decline, and other symptoms. METHODS Patients with symptomatic transsphenoidal encephaloceles who underwent staged treatment with intracranial and transpalatal cyst correction, facial bipartition, and cleft palate repair were studied (n = 4). Outcome measures included perioperative complications, recurrence, interdacyron distance comparison, and speech and developmental assessments. RESULTS The authors' staged correction of transsphenoidal encephaloceles as detailed in this article proved successful in all four patients, with no recurrence of meningitis, no cerebrospinal fluid leakage, alleviation of headaches, aesthetic improvement, and no encephalocele relapse. Skeletal correction by computed tomographic scan showed correction of interdacyron distance with a mean 22-mm reduction (56 percent). After the initial procedure of encephalocele correction, speech scores fell from 2.2 (borderline incompetent) to 7.9 (incompetent) but improved after the cleft palate repair and speech therapy to 1.4 (borderline competent). Follow-up developmental tests showed normal global evaluations in memory and attention skills in all but one patient (who had persistent deficiencies consistent with preoperative evaluations). CONCLUSION A staged operative treatment for symptomatic transsphenoidal encephaloceles offers functional and morphologic correction.
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Spacca B, Amasio ME, Giordano F, Mussa F, Busca G, Donati P, Genitori L. SURGICAL MANAGEMENT OF CONGENITAL MEDIAN PERISELLAR TRANSSPHENOIDAL ENCEPHALOCELES WITH AN EXTRACRANIAL APPROACH. Neurosurgery 2009; 65:1140-5; discussion 1145-6. [DOI: 10.1227/01.neu.0000351780.23357.f5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Median perisellar congenital transsphenoidal encephalocele (CTE) is a rare entity associated with multiple endocrine, visual, and respiratory deficits. The most likely causative factor for these pathological alterations is distension of neural structures (hypothalamic-pituitary system, optic pathway), resulting in protrusion of the dural sac through a sphenoid bone defect into the pharynx. The continuity with the extracranial space can be associated with an increased risk of tearing of the sac, with consequent cerebrospinal fluid leakage and subsequent increase in the risk of infection. We retrospectively reviewed the surgical treatment of CTE in our hospital using either an extracranial transoral or transnasal approach.
METHODS
We retrospectively reviewed our database. Between July 1994 and June 2005, CTE we identified 6 patients. Five of them were treated by a surgical intervention. The first patient was treated via a transcranial approach but had a relapse of the prolapse 11 years later. The relapse was treated with an extracranial transpalatal approach. Four patients were treated with an extracranial surgical approach: an extracranial transoral approach was performed in 2 cases, and an extracranial transnasal approach was used in the other 2 cases. Surgery was not performed in 1 patient because the parents refused to consent to the procedure.
RESULTS
Preoperative symptoms remained stable or improved in all of the patients after the surgical procedure and worsened in the patient who did not have a surgical intervention. Two patients experienced a palatal dehiscence. No mortality was recorded in this series of patients.
CONCLUSION
The surgical treatment of CTE is indicated to stop the progression or improve symptoms related to this disease entity. If approached correctly, the extracranial approach is a safe procedure with subsequent low morbidity.
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Affiliation(s)
- Barbara Spacca
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | | | - Flavio Giordano
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | - Federico Mussa
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | - Gianpaolo Busca
- Department of Otorhinolaryngology, Ospedale Maria Vittoria, Turin, Italy
| | - Pierarturo Donati
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | - Lorenzo Genitori
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
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Habu M, Niiro M, Toyoshima M, Kawano Y, Matsune S, Arita K. Transethmoidal meningoencephalocele involving the olfactory bulb with enlarged foramina of the lamina cribrosa--case report. Neurol Med Chir (Tokyo) 2009; 49:269-72. [PMID: 19556738 DOI: 10.2176/nmc.49.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 3-year-old girl presented with a transethmoidal meningoencephalocele manifesting as recurrent rhinorrhea. Initially, she developed meningitis, but after treatment she experienced rhinorrhea. Two months later, she again presented with rhinorrhea. Neuroimaging studies revealed a small protrusion (15 mm x 10 mm) at the roof of the ethmoidal sinus. Nasal endoscopy confirmed the diagnosis of meningoencephalocele. The operative findings revealed a small hole in the left olfactory bulb, which had descended into an enlarged foramen along with the arachnoid membrane. The left olfactory bulb was removed, and the enlarged foramina of the lamina cribrosa were covered with a frontal pericranial flap. The defect in the bone was very small, but contributed to the development of meningitis and leakage of the cerebrospinal fluid. Basal cephalocele should be considered in a patient with recurrent rhinorrhea and intracranial infections, even in the absence of any apparent anomaly.
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Affiliation(s)
- Mika Habu
- Department of Neurosurgery, Kagoshima University, Graduate School of Medicine and Dental Sciences, Kagoshima, Japan.
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22
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Seiberling KA, Wormald PJ. Case studies in the surgical management of nasal airway obstruction. Otolaryngol Clin North Am 2009; 42:405-17, xi. [PMID: 19328902 DOI: 10.1016/j.otc.2009.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article focuses on the workup and treatment of two distinct cases of nasal obstruction. The first case has to do with a 24-year old male who presented with a brief seizure. Review of systems was positive only for longstanding right nasal obstruction. Imaging studies were consistent with a meningoencephalocele. The patient was taken to surgery for excision of the nasal mass and repair of the skull-base defect. Case two involves the treatment of a male with chronic nasal obstruction due to an S-shaped septal deviation and turbinate hypertrophy. The case illustrates the role of endoscopic septoplasty and shows how the endoscopic septoplasty technique is applied. The article also discusses the management of the enlarged turbinates.
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Affiliation(s)
- Kristin A Seiberling
- Department of Otolaryngology Head and Neck Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South 5011, South Australia, Australia
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23
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Abstract
OBJECTS Craniopharyngeal Canal is a rare malformation of the sphenoid bone described in up to 0.42% of the asymptomatic population. It's been related to the development of the Rathke's pouch during embrionary period although some authors think it's a vestige of a former vascular channel. METHODS This report details a case of a four and a half years old child that developed recurrent meningitis associated with this anomaly. Its origin, clinical manifestations and treatment options are discussed. CONCLUSION Due to its low incidence and diagnostic difficulties, a high suspicion index is required while studying a case of recurrent meningitis or CSF leakage. Surgical approach is still controversial.
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Monteiro M, de Albuquerque AC, Nobre MC, Veloso AT, Mendes VA, de Souza Filho LD, da Silva MJ, Bicalho GVC. [Transspheinoidal transpalatal meningoencephalocele]. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 64:624-7. [PMID: 17119807 DOI: 10.1590/s0004-282x2006000400020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Accepted: 04/11/2006] [Indexed: 11/21/2022]
Abstract
Transspheinoidal meningoencephalocele is a rare presentation of dysraphism of the neural tube. It is characterized by the herniation of the neural tissue through a bony defect in the sphenoid bone. The clinical presentation is variable. It may be assymptomatic or it may include an upper airway obstruction, rhinorrhea, meningitis, hypothalamic dysfunction and optic anomalies. The surgical treatment is controversial. We describe the case of a 7-year-old boy who presented a pulsate structure filling the palate, palate digenesis and hypertelorism. The diagnosis of transsphenoidal transpalatal meningoencephalocele was confirmed by a computerized tomography and a magnetic resonance imaging. The child was operated on by the transpalatal/transspheinoidal approach with a good result.
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Affiliation(s)
- Marcílio Monteiro
- Hospital Santa Casa de Montes Claros, and Acadêmico do 8 período do curso de Medicina da Faculdade Estadual de Montes Claros (UNIMONTES), Brazil.
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25
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HASEGAWA S, HAYASHI N, KUBO M, HAMADA H, KUWAYAMA N, SHOJAKU H, AKAI T, ENDO S. Basal Encephalocele Associated With Hypoplasia of the Internal Carotid Artery -Case Report-. Neurol Med Chir (Tokyo) 2007; 47:572-5. [DOI: 10.2176/nmc.47.572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shinsaku HASEGAWA
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Nakamasa HAYASHI
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Michiya KUBO
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Hideo HAMADA
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Naoya KUWAYAMA
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Hideo SHOJAKU
- Department of Otolaryngology, University of Toyama, Faculty of Medicine
| | - Takuya AKAI
- Department of Neurosurgery, Kanazawa Medical University
| | - Shunro ENDO
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
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26
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Teng E, Heller J, Lazareff J, Kawamoto H, Wasson K, Garri JI, Bradley JP. Caution in Treating Transsphenoidal Encephalocele with Concomitant Moyamoya Disease. J Craniofac Surg 2006; 17:1004-9. [PMID: 17003634 DOI: 10.1097/01.scs.0000224988.40280.4a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A basal encephalocele is a rare congenital malformation involving a cranial bone defect and cystic-like herniation through the defect. Moyamoya is a rare cerebrovascular disease of unclear etiology involving occlusion of the distal internal carotids and formation of collateral vascular networks. Both diseases have been correlated with optic disc anomalies, hypopituitarism, and midfacial defects. We present a case of a 2-year-old boy with a midline facial cleft who underwent surgical correction of a basal encephalocele. His moyamoya disease may have contributed to a vascular complication. There is growing evidence indicating an overlap in disease profiles for these two rare diseases. In addition, molecular evidence indicates elevated levels of fibroblast growth factor and transforming growth factor in both diseases, suggesting common molecular pathways.
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Affiliation(s)
- Edward Teng
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, California 90095-6960, USA.
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27
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Hasegawa T, Sugeno N, Shiga Y, Takeda A, Karibe H, Tominaga T, Itoyama Y. Transethmoidal intranasal meningoencephalocele in an adult with recurrent meningitis. J Clin Neurosci 2006; 12:702-4. [PMID: 16115555 DOI: 10.1016/j.jocn.2004.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Accepted: 08/10/2004] [Indexed: 10/24/2022]
Abstract
Intranasal meningoencephalocele is a rarely encountered congenital malformation. We report a case of transethmoidal intranasal meningoencephalocele in a 52-year old man with recurrent purulent meningitis. After treatment of the acute meningitis, frontal craniotomy followed by the removal of the stalk of the meningoencephalocele and repair of the bony defect was successfully performed. He has had no further meningitis or CSF rhinorrhea post-operatively. Detailed neuroradiological examination and appropriate surgical treatment are important to prevent fatal neurological complications of intranasal meningoencephalocele.
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Affiliation(s)
- Takafumi Hasegawa
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan.
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28
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Van Esch H, Poirier K, de Zegher F, Holvoet M, Bienvenu T, Chelly J, Devriendt K, Fryns JP. ARX mutation in a boy with transsphenoidal encephalocele and hypopituitarism. Clin Genet 2004; 65:503-5. [PMID: 15151512 DOI: 10.1111/j.1399-0004.2004.00256.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fraioli B, Conti C, Lunardi P, Liccardo G, Fraioli MF, Pastore FS. Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: technical case report. Neurosurgery 2003; 52:1487-90; discussion 1490. [PMID: 12762897 DOI: 10.1227/01.neu.0000065183.05896.9c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2002] [Accepted: 02/12/2003] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Bernardo Fraioli
- Department of Neuroscience, Neurosurgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
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30
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Affiliation(s)
- G J Kaptain
- Department of Neurological Surgery, University of Virginia, Health Sciences Center, Charlottesville 22908-0212, USA.
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31
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Jabre A, Tabaddor R, Samaraweera R. Transsphenoidal meningoencephalocele in adults. SURGICAL NEUROLOGY 2000; 54:183-7; discussion 187-8. [PMID: 11077102 DOI: 10.1016/s0090-3019(00)00270-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transsphenoidal meningoencephalocele is a rare congenital anomaly, reported only in 14 adult patients. It may be subdivided into intrasphenoidal, extending into the sphenoid sinus, and true transsphenoidal, traversing the floor of the sinus and protruding into the nasal cavity or nasopharynx. METHODS We present the eighth case of true transsphenoidal meningoencephalocele reported in an adult. We review the literature and highlight the differences in clinical presentation and therapeutic management between patients with intrasphenoidal and true transsphenoidal meningoencephalocele. CONCLUSION Adult patients with intrasphenoidal meningoencephalocele often present with rhinorrhea and should be considered for transsphenoidal repair, whereas patients with true transsphenoidal meningoencephalocele should not undergo surgery, in view of the complex anatomy and the slow progression of symptoms.
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Affiliation(s)
- A Jabre
- Department of Neurosurgery, Boston University and Boston Veterans Administration Medical Center, Boston, Massachusetts 02118, USA
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32
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Koral K, Geffner ME, Curran JG. Trans-sphenoidal and sphenoethmoidal encephalocele: report of two cases and review of the literature. AUSTRALASIAN RADIOLOGY 2000; 44:220-4. [PMID: 10849991 DOI: 10.1046/j.1440-1673.2000.00788.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Basal encephaloceles are the least common form of encephalocele. Due to the critical position of the bony defect, visual and endocrinological abnormalities are frequently associated with basal encephaloceles. There is significant confusion in the classification of basal encephaloceles, particularly among trans-sphenoidal, sphenoethmoidal and intrasphenoidal subtypes. Two cases of basal encephaloceles are presented (one trans-sphenoidal and one sphenoethmoidal), along with a review of the literature. The relationship between the basal encephaloceles and endocrinological abnormalities is also emphasized.
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Affiliation(s)
- K Koral
- Department of Radiological Sciences, University of California Los Angeles School of Medicine, USA. www.childrensmemorial.org
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Kennedy EM, Gruber DP, Billmire DA, Crone KR. Transpalatal approach for the extracranial surgical repair of transsphenoidal cephaloceles in children. J Neurosurg 1997; 87:677-81. [PMID: 9347974 DOI: 10.3171/jns.1997.87.5.0677] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The surgical treatment of transsphenoidal cephaloceles in children is controversial. Reduction and repair via a transcranial approach are associated with high postoperative rates of morbidity, mortality, and hypothalamic dysfunction. In this study, four patients, aged 3 to 35 months at surgery, underwent successful transpalatal repair of two encephaloceles and two meningoceles. Two patients presented with nasal obstruction in infancy, one presented with unexplained meningitis, and in one patient the lesion was found incidentally during evaluation for seizures. Two children had median cleft face syndrome, another had an associated Arnold-Chiari type I malformation, and the fourth had no other cranial abnormalities. All patients underwent preoperative evaluation including magnetic resonance (MR) imaging. Auditory, ophthalmological, genetic, endocrinological, or other evaluation was undertaken as indicated. Lesions were approached through the median raphe of the hard and soft palates. All cephaloceles were easily visualized and dissected after division of the nasal palatal mucosa. The dural sac and its contents were reduced by surface coagulation after division and dissection of the overlying mucosa. Once reduced, the bone defect was obliterated in three of four patients. The dura was not opened and anomalous neural elements were not resected. At follow-up evaluation, all patients demonstrated resolution of preoperative symptoms without evidence of infection or lasting morbidity. Follow-up MR imaging showed reduction in all cases. The authors conclude that this transpalatal approach is safe and reliable for the treatment of transsphenoidal cephaloceles in young children.
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Affiliation(s)
- E M Kennedy
- Department of Plastic Surgery, University of Cincinnati, Children's Hospital Medical Center, and the Mayfield Clinic, Ohio, USA
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34
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Kapadia SB, Janecka IP, Fernandes S, Curtin H, Pollack I. Lateral basal Encephalocele of the Infratemporal Fossa. Otolaryngol Head Neck Surg 1996; 114:116-9. [PMID: 8570231 DOI: 10.1016/s0194-59989670296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S B Kapadia
- Department of Pathology, Presbyterian University Hospital, PA 15213-2582, USA
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35
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Morioka M, Marubayashi T, Masumitsu T, Miura M, Ushio Y. Basal encephaloceles with morning glory syndrome, and progressive hormonal and visual disturbances: case report and review of the literature. Brain Dev 1995; 17:196-201. [PMID: 7573760 DOI: 10.1016/0387-7604(95)00021-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report an 11-year-old girl with progressive hypopituitarism and visual loss of the right eye caused by trans-sphenoidal and sphenoethmoidal encephaloceles associated with morning glory syndrome. She was first seen at the age of 8 years, because of polydipsia and polyuria, and examination at that time revealed pituitary dwarfism and morning glory syndrome with visual disturbance of the right eye. Hormonal examinations revealed deficiency of growth hormone (GH) and anti-diuretic hormone (ADH). MR image showed trans-sphenoidal and sphenoethmoidal encephaloceles. At the age of 9 years, she was found at another institution to be blind in the right eye. Our examination of the patient at the age of 11 years revealed no change of the findings for the encephaloceles or optic system. Hormonal examination disclosed deficiencies of all hormones except for thyrotropin (TSH). This patient showed progressive hormonal and optic disturbances during the follow-up period. The natural course is still unclear, but our review of reported cases of trans-sphenoidal encephalocele with hormonal disturbance revealed that the most frequent findings were GH and ADH disturbance (over 60%), most patients (77.8%) showed progression of hormonal disturbance, and 40% of those with optic dysfunction showed progression. A patient with basal encephalocele with hormonal and / or optic disturbances requires careful long-term follow up.
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Affiliation(s)
- M Morioka
- Department of Neurosurgery, Kumamoto University Medical School, Japan
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36
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Repair of Temporosphenoidal Encephalocele with a Vascularized Split Calvarial Cranioplasty. Neurosurgery 1995. [DOI: 10.1097/00006123-199501000-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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37
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Clyde BL, Stechison MT. Repair of temporosphenoidal encephalocele with a vascularized split calvarial cranioplasty: technical case report. Neurosurgery 1995; 36:202-6; discussion 206. [PMID: 7708161 DOI: 10.1227/00006123-199501000-00029] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A 54-year-old woman was referred for the evaluation and treatment of spontaneous cerebrospinal fluid rhinorrhea. Magnetic resonance imaging revealed a right anteromedial intrasphenoidal encephalocele with cisternography showing the flow of contrast into the sphenoid encephalocele. Transcranial surgical repair was performed. This included the use of a vascularized split-thickness calvarial graft fixated over the cranial base defect with a titanium microplate. The technical details of this repair are discussed. Ten cases of temporosphenoidal encephaloceles have been reported. The literature concerning this rare form of encephalocele is reviewed.
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Affiliation(s)
- B L Clyde
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
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38
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39
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Abstract
Many diverse pathologic processes can involve the sphenoid bone because of its complex embryologic origin. In addition to primary neoplasia, the central location of the sphenoid predisposes it to involvement by many intracranial and extracranial lesions. The presence of multiple foramina and fissures offer "paths of least resistance" that allow the spread of pathology across the skull base. Sphenoid sinus disease also accounts for a number of pathologic entities occurring in this vicinity. This article reviews the more common lesions affecting the sphenoid bone as well as their CT and MR appearance.
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Affiliation(s)
- F J Laine
- Department of Radiology, Medical College of Virginia, Richmond 23298
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Buchfelder M, Fahlbusch R, Huk WJ, Thierauf P. Intrasphenoidal encephaloceles--a clinical entity. Acta Neurochir (Wien) 1987; 89:10-5. [PMID: 3324649 DOI: 10.1007/bf01406661] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the current classification basal encephaloceles are grouped together with real transsphenoidal encephaloceles. But those encephaloceles extending only into but not through the sphenoid sinus seem to represent a specific clinical entity and therefore should be regarded as a rare subgroup of sphenoidal encephaloceles. One personal case and six cases from the literature are reviewed, the own case being associated with an empty sella turcica. The initial sign is rhinorrhea, almost invariably. The association with other intracranial anomalies is uncommon. The extradural transsphenoidal or transethmoidal midline approach accompanied by a shunting procedure today is the most suitable method of surgical treatment.
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Affiliation(s)
- M Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Federal Republic of Germany
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