Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA.
J Neurosurg. 2010 May;112(5):1070-7. doi: 10.3171/2009.7.JNS0842.
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.
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.
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.
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.
蝶骨外侧窦自发性脑膜脑膨出是一种罕见的病变，其被认为是由于外侧颅咽管持续存在所致。先前对该病变的处理报告受到其相对罕见性的限制。本文的目的是报告内镜修复蝶骨窦自发性脑膜脑膨出的理论病因、手术技术和结果。
作者对涉及接受内镜修复蝶骨外侧窦自发性脑膜脑膨出的 13 例多机构患者系列进行了回顾性研究。讨论了手术技术和病理生理考虑因素。
临床表现包括 CSF 鼻漏（85%）、慢性头痛（77%）和脑膜炎病史（15%）。蝶骨外侧窦的内镜入路为经鼻（39%）、经翼突（23%）和经筛窦（39%）。2 例患者（8%）术后出现 CSF 漏，其中 1 例自行闭合，1 例需要内镜修复。在最近的随访中，所有患者均无漏液。1 例患者术后早期发生脑膜炎。
内镜经鼻内闭合是治疗蝶骨外侧窦自发性脑膜脑膨出的有效方法。如果蝶骨窦有广泛的外侧气腔化，充分暴露可能需要经翼突入路。
