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Transcranial extradural subtemporal repair for sphenoid sinus lateral recess meningoencephalocele: technical note

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Abstract

Cranial meningoencephalocele is a rare condition consisting of the herniation of meninges, CSF, and brain tissue through a cranial or skull base defect. Sphenoid sinus lateral recess meningoencephalocele is of particular interest due to the complex anatomy surrounding the bone defect and their demanding surgical management. In this technical note, we reported a step-by-step description of a rare case of sphenoid sinus lateral recess meningoencephalocele causing headache due to recurrent cerebrospinal fluid leak treated with a subtemporal craniotomy with extradural middle cranial fossa drilling and meningoencephalocele removal with multilayer reconstruction. The transcranial route is a safe and effective treatment for sphenoid sinus lateral recess meningoencephalocele repair. The subtemporal extradural approach allows for an optimal exposure of the relevant anatomy minimizing risks and improving the possibility to perform an effective multilayer skull base reconstruction.

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References

  1. Lai SY, Kennedy DW, Bolger WE (2002) Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus. Laryngoscope 112:1800–1805. https://doi.org/10.1097/00005537-200210000-00018

    Article  PubMed  Google Scholar 

  2. Van Nouhuys JM, Bruyn GW (1964) Nasopharyngeal transsphenoidal encephalocele: crater-like hole in the optic disk and agenesis of the corpus callosum. Pneumoencephalographic visualization in a case. Psychol Neurol Neurochir 67:243–258

    Google Scholar 

  3. Settecase F, Harnsberger HR, Michel MA, Chapman P, Glastonbury CM (2014) Spontaneous lateral sphenoid cephaloceles: anatomic factors contributing to pathogenesis and proposed classification. AJNR Am J Neuroradiol 35:784–789. https://doi.org/10.3174/ajnr.A3744

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE (2006) Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol 115:495–500. https://doi.org/10.1177/000348940611500703

    Article  PubMed  Google Scholar 

  5. Govindaraju R, Tang IP, Prepageran N (2019) Management of sphenoid lateral recess encephalocoeles. Curr Opin Otolaryngol Head Neck Surg 27:37–46. https://doi.org/10.1097/MOO.0000000000000508

    Article  PubMed  Google Scholar 

  6. Illing E, Schlosser RJ, Palmer JN, Curé J, Fox N, Woodworth BA (2014) Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg’s canal. Int Forum Allergy Rhinol 4:246–250. https://doi.org/10.1002/alr.21262

    Article  PubMed  Google Scholar 

  7. Jiang ZY, McLean C, Perez C, Barnett S, Friedman D, Tajudeen BA, Batra PS (2018) Surgical outcomes and postoperative management in spontaneous cerebrospinal fluid rhinorrhea. J Neurol Surg B Skull Base 79:193–199. https://doi.org/10.1055/s-0037-1606306

    Article  PubMed  Google Scholar 

  8. Quatre R, Attye A, Righini CA, Reyt E, Giai J, Schmerber S, Karkas A (2017) Spontaneous cerebrospinal fluid rhinorrhea: association with body weight and imaging data. J Neurol Surg B Skull Base 78:419–424. https://doi.org/10.1055/s-0037-1603731

    Article  PubMed  PubMed Central  Google Scholar 

  9. Della-Torre E, Campochiaro C, Cassione EB, Albano L, Gerevini S, Bianchi-Marzoli S, Bozzolo E, Passerini G, Lanzillotta M, Terreni M, Callea M, Trimarchi M, Mortini P, Tresoldi M, Acerno S, Dagna L (2018) Intrathecal rituximab for IgG(4)-related hypertrophic pachymeningitis. J Neurol Neurosurg Psychiatry 89:441–444. https://doi.org/10.1136/jnnp-2017-316519

    Article  PubMed  Google Scholar 

  10. Giunta G, Piazza I (1991) Recurrent bacterial meningitis occurring five years after closed head injury and caused by an intranasal post-traumatic meningo-encephalocele. Postgrad Med 67:377–379

    Article  CAS  Google Scholar 

  11. Lanzillotta M, Campochiaro C, Trimarchi M, Arrigoni G, Gerevini S, Milani R, Bozzolo E, Biafora M, Venturini E, Cicalese MP, Stone JH, Sabbadini MG, Della-Torre E (2017) Deconstructing IgG4-related disease involvement of midline structures: Comparison to common mimickers. Mod Rheumatol 27:638–645. https://doi.org/10.1080/14397595.2016.1227026

    Article  CAS  PubMed  Google Scholar 

  12. Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH (2013) Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele: a systematic review of outcomes. J Neurol Surg A Cent Eur Neurosurg 74:239–250. https://doi.org/10.1055/s-0032-1325636

    Article  PubMed  Google Scholar 

  13. Biafora M, Bertazzoni G, Trimarchi M (2014) Maxillary sinusitis caused by dental implants extending into the maxillary sinus and the nasal cavities. J Prosthodont 23:227–231. https://doi.org/10.1111/jopr.12123

    Article  PubMed  Google Scholar 

  14. Gagliardi F, Donofrio CA, Spina A, Bailo M, Gragnaniello C, Gallotti AL, Elbabaa SK, Caputy AJ, Mortini P (2016) Endoscope-assisted transmaxillosphenoidal approach to the sellar and parasellar regions: an anatomic study. World Neurosurg 95:246–252. https://doi.org/10.1016/j.wneu.2017.08.022

    Article  PubMed  Google Scholar 

  15. Trimarchi M, Bellini C, Toma S, Bussi M (2012) Back-and-forth endoscopic septoplasty: analysis of the technique and outcomes. Int Forum Allergy Rhinol 2:40–44. https://doi.org/10.1002/alr.20100

    Article  PubMed  Google Scholar 

  16. Cheung DK, Attia EL, Kirkpatrick DA, Marcarian B, Wright B (1993) An anatomic and CT scan study of the lateral wall of the sphenoid sinus as related to the transnasal transethmoid endoscopic approach. J Otolaryngol 22:63–68

    CAS  PubMed  Google Scholar 

  17. Maxfield AZ, Mueller SK, Raquib AR, Sedaghat AR, Bergmark RW, Metson RB, Holbrook EH, Bleier BS, Gray ST (2020) Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning. Laryngoscope Investig Otolaryngol 5:375–380. https://doi.org/10.1002/lio2.412

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schmidt RF, Choudhry OJ, Raviv J, Baredes S, Casiano RR, Eloy JA, Liu JK (2012) Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles. Neurosurg Focus 32:E5. https://doi.org/10.3171/2012.3.focus1267

    Article  PubMed  Google Scholar 

  19. Shintoku R, Tosaka M, Shimizu T, Yoshimoto Y (2018) Transcranial and epidural approach for spontaneous cerebrospinal fluid leakage due to meningoencephalocele of the lateral sphenoid sinus. Asian J Neurosurg 13:462–464. https://doi.org/10.4103/1793-5482.228579

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tabaee A, Anand VK, Cappabianca P, Stamm A, Esposito F, Schwartz TH (2010) Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus. J Neurosurg 112:1070–1077. https://doi.org/10.3171/2009.7.JNS0842

    Article  PubMed  Google Scholar 

  21. Tomazic PV, Stammberger H (2009) Spontaneous CSF-leaks and meningoencephaloceles in sphenoid sinus by persisting Sternberg’s canal. Rhinology 47:369–374. https://doi.org/10.4193/Rhin08.236

    Article  PubMed  Google Scholar 

  22. Trimarchi M, Bellini C, Fabiano B, Gerevini S, Bussi M (2009) Multiple mucosal involvement in cicatricial pemphigoid. Acta Otorhinolaryngol Ital 29:222–225

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Boari N, Roberti F, Biglioli F, Caputy AJ, Mortini P (2010) Quantification of clival and paraclival exposure in the Le Fort I transmaxillary transpterygoid approach: a microanatomical study. J Neurosurg 113:1011–1018. https://doi.org/10.3171/2010.4.jns091887

    Article  PubMed  Google Scholar 

  24. Bolger WE (2005) Endoscopic transpterygoid approach to the lateral sphenoid recess: surgical approach and clinical experience. Otolaryngol Head Neck Surg 133:20–26

    Article  Google Scholar 

  25. Bolger WE, Osenbach R (1999) Endoscopic transpterygoid approach to the lateral sphenoid recess. Ear Nose Throat J 78:36–46

    Article  Google Scholar 

  26. Roberti F, Boari N, Mortini P, Caputy AJ (2007) The pterygopalatine fossa: an anatomic report. J Craniofac Surg 18:586–590. https://doi.org/10.1097/scs.0b013e31805343c2

    Article  PubMed  Google Scholar 

  27. Bendersky DC, Landriel FA, Ajler PM, Hem SM, Carrizo AG (2011) Sternberg’s canal as a cause of encephalocele within the lateral recess of the sphenoid sinus: a report of two cases. Surg Neurol Int 2:171. https://doi.org/10.4103/2152-7806.90034

    Article  PubMed  PubMed Central  Google Scholar 

  28. Samadian M, Moghaddasi H, Vazirnezami M, Haddadian K, Rezaee O, Armanfar M, Khormaee F (2012) Transcranial approach for spontaneous CSF rhinorrhea due to Sternberg’s canal intrasphenoidal meningoencephalocele: case report and review of the literature. Turk Neurosurg 22:242–245. https://doi.org/10.5137/1019-5149.jtn.2902-10.1

    Article  PubMed  Google Scholar 

  29. Zoli M, Farneti P, Ghirelli M, Giulioni M, Frank G, Mazzatenta D, Pasquini E (2016) Meningocele and meningoencephalocele of the lateral wall of sphenoidal sinus: the role of the endoscopic endonasal surgery. World Neurosurg 87:91–97. https://doi.org/10.1016/j.wneu.2015.11.001

    Article  PubMed  Google Scholar 

  30. Gagliardi F, Bailo M, Spina A, Boari N, Donofrio CA, Piloni M, Gragnaniello C, Caputy AJ, Mortini P (2017) Bilateral temporal myofascial flap for the reconstruction of frontal sinus defects. World Neurosurg 107:477–481. https://doi.org/10.1002/hed.25896

    Article  PubMed  Google Scholar 

  31. Gagliardi F, Piloni M, Bailo M, Gragnaniello C, Nocera G, Boari N, Spina A, Caputy AJ, Mortini P (2019) Temporal myofascial segmentation for multilayer reconstruction of middle cranial fossa floor after extradural subtemporal approach to the clival and paraclival region. Head Neck 41:3631–3638. https://doi.org/10.1002/hed.25896

    Article  PubMed  Google Scholar 

  32. Ojemann RG (1992) Skull-base surgery: a perspective. J Neurosurg 76:569–570. https://doi.org/10.3171/jns.1992.76.4.0569

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy

    Alfio Spina, Nicola Boari, Francesco Calvanese, Pierfrancesco De Domenico & Pietro Mortini

  2. Department of Neurology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Miryam Cannizzaro

  3. Department of Otorhinolaryngology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Matteo Trimarchi

Authors
  1. Alfio Spina
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  2. Nicola Boari
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  3. Francesco Calvanese
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  4. Pierfrancesco De Domenico
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  5. Miryam Cannizzaro
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  6. Matteo Trimarchi
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  7. Pietro Mortini
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Contributions

Conceptualization: Alfio Spina, Nicola Boari; methodology, formal analysis, and investigation: Alfio Spina, Nicola Boari, Francesco Calvanese, Piefrancesco De Domenico; writing (original draft preparation): Alfio Spina, Nicola Boari, Francesco Calvanese, Piefrancesco De Domenico, Myriam Cannizzaro; writing (review and editing): all authors; supervision: Matteo Trimarchi, Pietro Mortini.

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Correspondence to Alfio Spina.

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Spina, A., Boari, N., Calvanese, F. et al. Transcranial extradural subtemporal repair for sphenoid sinus lateral recess meningoencephalocele: technical note. Neurosurg Rev 45, 903–909 (2022). https://doi.org/10.1007/s10143-021-01581-7

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