Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video
Encephaloceles are considered rare with an approximate incidence of 1 in 35,000, and sphenoid encephaloceles are even more uncommon.2 Two types of sphenoid encephaloceles exist: medial perisellar encephaloceles, and lateral sphenoidal encephaloceles. Surgical correction of the lateral sphenoid reces...
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Elsevier
2025-01-01
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| Series: | World Neurosurgery: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139724001339 |
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| author | Ryan W. Sindewald Michael G. Brandel Arvin R. Wali Carol H. Yan David R. Santiago-Dieppa |
| author_facet | Ryan W. Sindewald Michael G. Brandel Arvin R. Wali Carol H. Yan David R. Santiago-Dieppa |
| author_sort | Ryan W. Sindewald |
| collection | DOAJ |
| description | Encephaloceles are considered rare with an approximate incidence of 1 in 35,000, and sphenoid encephaloceles are even more uncommon.2 Two types of sphenoid encephaloceles exist: medial perisellar encephaloceles, and lateral sphenoidal encephaloceles. Surgical correction of the lateral sphenoid recess encephalocele is achieved via one of two endoscopic approaches: extended sphenoidotomy or transpterygopalatine. Extended sphenoidotomy is preferred if the angle between the access door and lateral extension of bone defect is greater than 35°1. Otherwise, the transpterygopalatine approach is used. Intraoperative video demonstrating an extended sphenoidotomy approach to correcting a lateral recess sphenoidal encephalocele has not previously been published.Here we present a case of a 41-year-old female who presented with meningitis, a cerebrospinal fluid leak, and an incidental sphenoid mass. Brain MRI redemonstrated the mass in the sphenoid sinus consistent with an encephalocele occupying Sternberg's Canal. The patient consented to the procedure. The video demonstrates the skull base approach, encephalocele extraction, collagen inlay, and nasal septal bone and vascularized pedicled nasoseptal flap placement. Postoperative imaging confirmed the placement of the collagen inlay and nasal septal bone autograft. The patient recovered from surgery and was discharged on post-operative day 3 with no cerebrospinal fluid (CSF) leak recurrence. Postoperative follow up demonstrated viable nasoseptal graft without evidence of CSF leak.For patients with favorable anatomy, an extended sphenoidotomy approach to lateral sphenoid sinus encephalocele resection is a preferred alternative to the transpterygoid approach. This surgical video demonstrates the technique for managing lateral sphenoid sinus encephaloceles occupying Sternberg's canal, including endonasal approach, encephalocele resection and posterior sphenoid wall repair. |
| format | Article |
| id | doaj-art-3e833f33d8a04563a9b4df6cb524e1b5 |
| institution | Kabale University |
| issn | 2590-1397 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj-art-3e833f33d8a04563a9b4df6cb524e1b52025-02-10T04:34:48ZengElsevierWorld Neurosurgery: X2590-13972025-01-0125100402Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative videoRyan W. Sindewald0Michael G. Brandel1Arvin R. Wali2Carol H. Yan3David R. Santiago-Dieppa4UC San Diego School of Medicine, San Diego, CA, USA; Corresponding author.Department of Neurosurgery, University of California San Diego, San Diego, CA, USADepartment of Neurosurgery, University of California San Diego, San Diego, CA, USADepartment of Otolaryngology, University of California San Diego, San Diego, CA, USADepartment of Neurosurgery, University of California San Diego, San Diego, CA, USAEncephaloceles are considered rare with an approximate incidence of 1 in 35,000, and sphenoid encephaloceles are even more uncommon.2 Two types of sphenoid encephaloceles exist: medial perisellar encephaloceles, and lateral sphenoidal encephaloceles. Surgical correction of the lateral sphenoid recess encephalocele is achieved via one of two endoscopic approaches: extended sphenoidotomy or transpterygopalatine. Extended sphenoidotomy is preferred if the angle between the access door and lateral extension of bone defect is greater than 35°1. Otherwise, the transpterygopalatine approach is used. Intraoperative video demonstrating an extended sphenoidotomy approach to correcting a lateral recess sphenoidal encephalocele has not previously been published.Here we present a case of a 41-year-old female who presented with meningitis, a cerebrospinal fluid leak, and an incidental sphenoid mass. Brain MRI redemonstrated the mass in the sphenoid sinus consistent with an encephalocele occupying Sternberg's Canal. The patient consented to the procedure. The video demonstrates the skull base approach, encephalocele extraction, collagen inlay, and nasal septal bone and vascularized pedicled nasoseptal flap placement. Postoperative imaging confirmed the placement of the collagen inlay and nasal septal bone autograft. The patient recovered from surgery and was discharged on post-operative day 3 with no cerebrospinal fluid (CSF) leak recurrence. Postoperative follow up demonstrated viable nasoseptal graft without evidence of CSF leak.For patients with favorable anatomy, an extended sphenoidotomy approach to lateral sphenoid sinus encephalocele resection is a preferred alternative to the transpterygoid approach. This surgical video demonstrates the technique for managing lateral sphenoid sinus encephaloceles occupying Sternberg's canal, including endonasal approach, encephalocele resection and posterior sphenoid wall repair.http://www.sciencedirect.com/science/article/pii/S2590139724001339EncephaloceleExtended sphenoidotomySternberg's canalTranspterygoidTranspterygopalatine |
| spellingShingle | Ryan W. Sindewald Michael G. Brandel Arvin R. Wali Carol H. Yan David R. Santiago-Dieppa Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video World Neurosurgery: X Encephalocele Extended sphenoidotomy Sternberg's canal Transpterygoid Transpterygopalatine |
| title | Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video |
| title_full | Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video |
| title_fullStr | Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video |
| title_full_unstemmed | Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video |
| title_short | Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video |
| title_sort | surgical management of a lateral sphenoid sinus encephalocele 2 dimensional operative video |
| topic | Encephalocele Extended sphenoidotomy Sternberg's canal Transpterygoid Transpterygopalatine |
| url | http://www.sciencedirect.com/science/article/pii/S2590139724001339 |
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